[MELALIB 15: A retrospective observational study of 383 cases of melanoma diagnosed by dermatologists in private practice]. / MELALIB15 : étude observationnelle rétrospective de 383 mélanomes dépistés par des dermatologues libéraux.

BACKGROUND: Early detection of melanoma constitutes a major challenge and is a common reason for dermatological consultations. There is no recent data on melanomas diagnosed in the private medical sector in France, nor on the circumstances of diagnosis. PATIENTS AND METHODS: This was a retrospective observational study on records collating data on all new consecutive cases of melanoma diagnosed between January 2015 and June 2018, in the private sector only, by volunteer dermatologists belonging to the association for continuing medical education, "Dermatologie Paris XV". A data collection sheet was prepared on which to record information about the dermatologist, the patient, the main complaint, the characteristics of the melanoma, and the initial treatment given, using the computerized list provided by our dermatopathology offices. RESULTS: The study involved 383 cases of melanoma, 37% in situ and 63% invasive, which consisted chiefly of superficial spreading melanoma. The median age of the cohort was 61 years and patients were predominantly female (58%). Follow-up of high-risk patients and complete routine examination (in those consulting for another reason) resulted in direct detection by a dermatologist of 202 of the 383 melanomas (52.7%); these melanomas had a lower median Breslow index than the rest of the cohort and were thin in the main. When patients consulted for a suspect lesion (139 cases), the lesion had been identified mostly by either the patient or by a relative (61% of cases). The decision to consult was made chiefly by the patients themselves, and the Breslow index was thicker. An initial consultation for nevus screening resulted in diagnosis of 42 melanomas, i.e. only 11% of the cohort. Dermoscopy was performed by 92% of the dermatologists participating in the study. Melanoma excision was performed in the office by the practitioner in 75% of cases, and management was validated at multidisciplinary meetings in 65% of cases. CONCLUSION: In terms of French primary care, dermatologists in private practice play a key role in ensuring early detection and initial management of melanoma.

The effects of partial carpal fusions on wrist range of motion.

UNLABELLED: The objective of this investigation was to evaluate the effects of different partial wrist fusions on wrist motion. A total of 20 cadaveric wrists were tested in the intact state and after undergoing either a four-corner fusion or 2- and 3-bone fusion. The moment-rotation behaviour was measured in 24 directions of wrist motion about the forearm axis. The 2- and 3-bone fusion groups demonstrated increased radial deviation and pure flexion. Pure flexion was decreased in the four-corner fusion group. Radial extension and pure extension were decreased in all treatments compared with normal range of motion. Increasing the number of carpal bones within the fusion construct did not alter the functional axis of the wrist. Essentially equivalent motion is possible with 2-bone, 3-bone and four-corner fusions, with the exceptions of pure flexion and radial deviation. This data may influence surgeons when choosing between treatment methods. LEVEL OF EVIDENCE: N/A.

[Value of a computer-assisted screening method (PAPNET) for the detection of infectious cervico-uterine smears]. / Intérêt du système de lecture assistée par ordinateur (PAPNET) pour la détection des frottis cervico-utérins infectieux.

There have been several reports regarding the accuracy of the PAPNET system applied to the screening for cancerous and precancerous lesions. Based on neuronal networks, this computerized tool was initially trained to select atypical cells. It has been approved in the USA for the re-screening of cervical smears for quality assurance. However, its particular behaviour has not been frequently studied when the system is designed to detect frequent infectious organisms. We report the results of re-screening of 42 inflammatory cervico-uterine smears by the PAPNET system. The computerized images were reviewed by two different pathologists, with complete agreement between the two observers in 39 cases. Infectious organisms were detected in only 66% of cases. Trichomonas, mycoses and Gardnerella were diagnosed in 63%, 56% and 87% of cases respectively. No herpetic lesions were identified. The low accuracy of the PAPNET system in the diagnosis of infectious cervico-uterine smears should be taken into account if this system is developed as an exclusive pre-screening method.

A European de facto standard for image folders applied to telepathology and teaching.

Since 1980, French pathologists at ADICAP (Association pour le Développement de l'Informatique en Cytologie et en Anatomie Pathologique) have created a common language code allowing the use of computers for routine applications. This code permitted the production of an associated exhaustive image bank of approximately 30,000 images. This task involved many specialists necessitating the definition of specific processes for security and simplicity of data handling. In particular, it has been necessary to develop image communication. To achieve that goal, it was necessary to define a folder, associating textual information to images. That was done through several industrial software providers contribution. Consequently, this folder, using a common packaging standard, allowed any pathologist access to images, codified data and clinical information. Accessing folders has been made easy by launching a Web server at CRIHAN under the supervision of ADICAP. An ADICAP software user may not only browse through the folder but may also import them into their own system and produce new folders. Today more than a hundred users in France and in foreign countries are able to provide diagnostic advice and also referential products useful for further education and quality control. The next challenge is the development of this preliminary de facto approach toward an internationally admitted standard suited for morphological image exchange.

Glomus tumor of the fat pad.

The authors report an exceptional glomus tumor location in Hoffa's ligament in a 65-year-old man. Based on this observation and a literature review, the authors provide the clinical and radiographic diagnostic appearances of this type of tumor. Surgical removal of the tumor achieved immediate disappearance of knee pain. Histological examination of the tumor has established the definitive diagnosis.

[Contribution of computers and telepathology in cancerologic pathology]. / Apport de l'informatique et de la télépathologie en anatomocytopathologie cancérologique.

The histologic or cytologic diagnosis of a tumoral lesion may be sometimes very difficult to do even for a senior pathologist. Nevertheless, it is necessary to recognize a malignant process with reliability and security. The usual way to solve some difficult problems is firstly to search documentations in books or atlas and then to discuss the slides in common. Sometimes it is necessary to dispatch the original documents to a national or international expert. Now computers are used in any private or public department of Pathology. Some new informatics developments allow to send good digitized pictures to an expert and to discuss with him. It is also possible to elaborate a data base of digitized images which can be edited on CD-Rom. We describe the development and the use of these technics in France and elsewhere. It seems that they could have an increasing role for quality assurance in tumoral pathology.

Telepathology in France. Justifications and developments.

Since 1985, the French National Association ADICAP (Association for the promotion of computer use in Cytology and Anatomic Pathology) has been active in the creation a microscope workstation for developing a bank of digitized images to be used for diagnostic and educational purposes. In 1989 one of the authors (P. Dusserre) has created a first telepathology network using this workstation. Since then, 32 workstations have been set up in private and public Departments of Pathology. Two of them are located overseas, in the Martinique and Guadeloupe islands. In this paper, the authors describe this system, called Transpath, which is a multi-purpose and modulable workstation. 3-years experience and several accuracy tests have shown that the quality of transmitted images ensure a reliable diagnosis in more than 95% of cases. It has been decided to extend this service to other French overseas territories and to develop a group of experts. The images bank will also be developed and recorded on CD-ROM. The authors intend to participate in a future European project (PILOT project, i.e. Pathology International and Local Operational Telematics), with the purpose of establishing real intercommunication between European and other networks on a worldwide basis.

[Reliability of the anatomopathological diagnosis by static image transfer]. / Fiabilité du diagnostic anatomo-pathologique par transmission d'images statiques.

50 hepatic biopsies and 50 prostatic biopsies were submitted for diagnostic to an expert by the mean of static images previously digitalized by a consulting pathologist. Accuracy of diagnosis was obtained in 2 minutes with 4 images in 86% of cases. Additional data such as new images, several power fields, permitted accuracy of diagnosis in 98% of the cases. The experiences showed clearly that the quality of the transferred static images is sufficient to allow diagnoses. It pointed out the importance of the different actors involved in the consultation. It illustrates the possible use of this system as a training tool.

Contribution to the study of the multidimensional variational network of the human gerontogenesis.

The present paper makes a contribution to the study of the multidimensional variational network of the human gerontogenesis (G. Acalugaritei, 1993-1995). In this respect was rendered evident the variation of the multiple regression coefficient (R) in relation to four sets of variables, as follows: a set of fundamental variables, a set of variational variables (variation ranks of the R), a set of reference variables (R, aging, blood pressure, sex and ABO genetic system) and a set of relational variables (relations).

Long-range organization and sequence-directed curvature of Xenopus laevis satellite 1 DNA.

We have investigated the long-range organization and the intrinsic curvature of satellite 1 DNA, an unusual tandemly-repeated DNA family of Xenopus laevis presenting sequence homologies to SINEs. PFGE was used in combination with frequent-cutter restriction enzymes not likely to cut within satellite 1 DNA and revealed that almost all the repeating units are tandemly organized to form large arrays (200 kb to 2 Mb) that are marked by restriction length polymorphism and contain intra-array domains of sequence variation. Besides that, we have analysed the secondary structure of satellite 1 DNA by computer modelling. Theoretical maps of curvature obtained from three independent models of DNA bending (the dinucleotide wedge model of Trifonov, the junction model of Crothers and the model of de Santis) showed that satellite 1 DNA is intrinsically curved and these results were confirmed experimentally by polyacrylamide gel electrophoresis. Moreover, we observed that this bending element is highly conserved among all the members of the satellite 1 DNA family that are accessible to analysis. A potential genetic role for satellite 1 DNA based on this unusual structural feature is discussed.

Molecular dissection of a specific nuclear domain: the chromatin region of the ribosomal gene cluster in Xenopus laevis.

Molecular dissection of the nuclear domain corresponding to the ribosomal chromatin cluster was investigated. The experimental scheme was based on the ability of restriction enzymes to digest the whole genome without affecting this region (several megabases in length). Such a strategy involved the judicious choice of restriction enzymes, which is possible in Xenopus laevis, where the rDNA sequence is known and the repeated units are organized into one unique cluster. SalI, XhoI, and EcoRV digestion produced frequent cutting of the genome leaving the ribosomal cluster intact. Isolation of the rDNA cluster was confirmed by separation of the digested DNA by pulsed-field electrophoresis. When applied to purified nuclei, this approach allowed the isolation of the ribosomal chromatin cluster under very mild conditions: no cleavages (either enzymatic or mechanical) were detectable. Since the purification scheme depends only on the DNA sequence outside of the rDNA cluster, it permits the obtention of this domain in different functional states. Electron microscopic analysis demonstrated that the domain organization is substantially preserved and maintains its looped organization (the size and the full number of loops were preserved). This purification scheme provides a powerful tool for studying the structure-function relationships within the ribosomal nuclear domain.

Supragenic loop organization: mapping in Drosophila embryos, of scaffold-associated regions on a 800 kilobase DNA continuum cloned from the 14B-15B first chromosome region.

The supragenic loop organization of the Drosophila genome was investigated on a 800 kilobase (kb) DNA continuum from the 14B-15B first chromosome region. Nuclear scaffolds from 0-18 hr embryos were prepared with Laemmli's low-salt, detergent procedure and digested with restriction enzymes. Scaffold-associated regions (SARs) were mapped by probing Southern transfers of total, scaffold-associated and free DNA with a set of 70 recombinant phages overlapping the investigated genomic region. In all, 85 restriction fragments showed association to scaffolds. 12 of them were present in the majority of scaffolds. They bore strong SARs organizing the DNA molecule as consecutive loops with sizes ranging from 15 to 115 kb. 44 were present in only a fraction of scaffolds. They contained weak SARs subdividing the basic loops into smaller ones. 29 additional restriction fragments were present in a very small fraction of scaffolds. The position of SARs with respect to transcribed regions was investigated. Strong SARs appeared to be located on untranscribed DNA and to frame transcription units. In contrast, at least some weak SARs were shown to comap with transcribed regions or to reside within characterized transcription units. Statistical analyses established that strong and weak SARs were periodically positioned on the DNA continuum and that there was a potential contact point between scaffolds and the DNA continuum every 11 kb, or multiples thereof. Implications for SAR role(s) are discussed.

Developmental expression pattern of a 800 kb DNA continuum cloned from the Drosophila X chromosome 14B-15B region.

The expression throughout development of a long DNA segment from the Drosophila genome was investigated. A near continuum of 800 kb DNA was cloned by extending a 90 kb previous chromosome walk, spanning the rudimentary locus (r), and by initiating 2 chromosome walks from an isolated DNA clone located next to the r locus. Hexanucleotide-primed single strand cDNAs were synthesized from poly(A)+ RNAs prepared from staged embryos, larvae, pupae, males, females, heads from adults and thoraces plus abdomens from adults. The representativity of the cDNAs with regard to the whole length and the molar abundance of a selected gene mRNA was checked. These cDNAs were then used to probe Southern transfers of the cloned DNA after digestion with combinations of restriction enzymes. The limits of the expressed parts of the cloned DNA and their developmental profiles were then deduced. Data show that, in contrast to what was known on the basis of genetic analysis, this region of the Drosophila genome is densely transcribed. Numerous parts of the cloned DNA are found to be stage-, or sex- or territory-specifically expressed. Data are consistent with a view of the organization of this representative part of the Drosophila genome according to which the expressed regions tend to be clustered, whereas no tendency for transcription units displaying comparable specific spatial, temporal or sex expression patterns to be arranged in groups is noted.

[Synovial osteochondromatosis of the knee and synovial chondrosarcoma. Report of 2 cases]. / Ostéochondromatose synoviale du genou et chondrosarcome synovial. A propos de 2 cas.

The possible transformation of synovial osteochondromatosis into chondrosarcoma is rarely reported in the literature, as well as the coexistence of the two entities. The authors have observed two such cases. The first one was discovered by arthroscopy in the course of a synovial osteochondromatosis associated with a posterior tumour proved secondarily as being a chondrosarcoma. On the contrary, the second case presented as a destroying tumour invading the entire joint and proved secondarily as being a benign osteochondromatosis. Cartilaginous masses very important may lead to bone destruction in the course of benign osteochondromatosis. However, in such cases, the possibility of an associated or a secondary chondrosarcoma must be looked for using radiology, arthroscopy and microscope examination.

[Osteonecrosis of the femur head in patients with renal transplant. Apropos of 82 surgically treated hips]. / L'ostéonécrose de la tête fémorale chez le transplanté rénal. A propos de 82 hanches opérées.

Fifty-six renal transplanted patients having an average age of 33 years have been operated on for necrosis of the femoral head from 1973 to 1988. They totalise 85 cephalic necrosis due to the therapeutic peaks of corticotherapy. The femoral condyles were affected by the necrosis in 21 patients, and the humeral head in 16 patients. 82 surgical operations of first intention and 18 resumptions leading to 100 the total number of operations. The 26 drilling gave place to 11 by arthroplasty. The good results of the drillings only concern the infraradiological stages and the MRI allows to detect the non symptomatic stages 0. The 33 intermediate prosthesis did not lead to septic complications but 9 cotiloidal alterations of which 4 important with a resumption by total prosthesis. 36 total prosthesis were realized out of which 13 for resumption. Two early and two late suppurations after septicemia complicated the evolution. If at stage 0 or 1 the drilling seems to remain a reliable indication, the total prosthesis is the only possible solution for invalidating stages IV, the intermediate prosthesis seems to be able to keep a place in the intermediate stages.

[Beta-2 microglobulin and amyloid osteoarthropathy in patients undergoing chronic hemodialysis]. / Bêta-2-microglobuline et ostéo-arthropathies amyloïdes de l'hémodialysé chronique.

The incidence of beta-2 microglobulin amyloidosis was assessed in two populations of chronic hemodialysis patients. Out of 34 patients who underwent biopsy during orthopedic surgery (33 cases) or autopsy (1 case), 26 had amyloid deposits which fixed anti-beta microglobulin serum. Out of 55 unselected patients treated for over months at the dialysis centre, 14 (25%) had clinical symptoms suggesting amyloidosis and out of 43 patients who had a systematic radiological skeletal survey, 23 (53%) had bone deposits. The plasma beta microglobulin concentrations (about 20 times the normal value) we not significantly different whether or not the patients had histological proven amyloidosis, clinically or radiologically probable amyloidosis, no detectable amyloidosis. However, the duration of hemodialysis was longer in those with proven or highly probable amyloidosis. The finding illustrate the indirect role of elevation of beta-2 microglobulin in the genesis of this pathology and also the necessity of lowering its concentration in order to avoid the long term complications of osteoarticular deposits, the functional consequences of which may be very serious.