Intratumoural budding (ITB) in preoperative biopsies predicts the presence of lymph node and distant metastases in colon and rectal cancer patients.

BACKGROUND: In colorectal cancer (CRC), tumour budding at the invasion front is associated with lymph node (LN) and distant metastasis. Interestingly, tumour budding can also be detected in biopsies (intratumoural budding; ITB) and may have similar clinical importance. Here we investigate whether ITB in preoperative CRC biopsies can be translated into daily diagnostic practice. METHODS: Preoperative biopsies from 133 CRC patients (no neoadjuvant therapy) underwent immunohistochemistry for pan-cytokeratin marker AE1/AE3. Across all biopsies for each patient, the densest region of buds at × 40 (high-power field; HPF) was identified and buds were counted. RESULTS: A greater number of tumour buds in the biopsy was associated with pT stage (P=0.0143), LN metastasis (P=0.0007), lymphatic (P=0.0065) and venous vessel invasion (P=0.0318) and distant metastasis (cM1) (P=0.0013). Using logistic regression, a 'scale' was developed to estimate the probability of LN and distant metastasis using the number of tumour buds (e.g. 10 buds per HPF: 64% chance of LN metastasis; 30 buds per HPF: 86% chance). Inter-observer agreement for ITB was excellent (intraclass correlation coefficient: 0.813). CONCLUSION: Tumour budding can be assessed in the preoperative biopsy of CRC patients. It is practical, reproducible and predictive of LN and distant metastasis. Intratumoural budding qualifies for further investigation in the prospective setting.

[Predictive value of aortic atherosclerosis detected by transoesophageal echocardiography for the presumption of coronary artery disease]. / Valeur prédictive de l'athérosclérose aortique détectée par l'échocardiographie transoesophagienne dans la présomption de l'athérosclérose coronaire.

The aim of this study was to determine the relationship between plaques of aortic atheroma detected by transoesophageal echocardiography and the condition of the coronary arteries at coronary angiography. Two hundred and seventeen consecutive patients were included for systematic transoesophageal echocardiography blinded to the results of coronary angiography. Significant coronary disease was defined as stenosis of at least 70% of the artery lumen. Aortic atherosclerosis was classified in four grades. The average age of the patients was 54.5 +/- 10.5 years. The sex ratio was 2.55 in favour of men. The average coronary score was 5 +/- 4.5 and the lesion index was 1.1 +/- 0.96. One hundred and fifty-nine patients had aortic atheroma, 73% of which (80 cases) were complex lesions. The descending aorta was the commonest site (91%) followed by the transverse (40% and ascending aorta (14%). When the ascending aorta was affected there was a very significant association with coronary artery disease (100% of cases). Sixty-one per cent of patients had lesions of one aortic segment, 28% had lesions of two aortic segments and in 10%, all three aortic segments were involved. The presence of aortic atheroma was correlated with coronary artery disease with a sensitivity and specificity of 86% and 76% respectively. The positive and negative predictive values were 81% and 31% respectively. Seventy-five per cent of patients with a coronary score of at least 7 had aortic atheroma with complex lesions in 47% of cases. The lesion index was significantly higher in this group when the coronary score was less than 7 (1.98 +/- 0.8 vs 0.65 +/- 0.7, p<0.00001). Patients with coronary artery disease have more complex lesions of the descending than of the ascending aorta (94 vs 25%). Significant coronary artery disease was correlated with the presence of aortic atheroma, especially of the ascending aorta. The specificity and positive predictive values were 100% but the negative predictive value was poor, irrespective of the aortic segment involved (32% for the ascending aorta, 36% for the transverse and 35% for the descending aorta). The authors conclude that transoesophageal echocardiography of the thoracic aorta is a good method of predicting severe coronary atherosclerotic disease.

[Thoracic ectopia cordis with tetralogy of fallot]. / Ectopia cordis thoracique associe a une tetralogie de Fallot.

Ectopia cordis; very rare congenital malformation, characterized by an evisceration of the heart through a parietal defect. The thoracic localization is most frequent. We report the case of a full term baby girl without follow-up of the pregnancy, presenting a beating mass in thoracic position, expansive to the effort, covered by a translucent membrane corresponding to an ectopique position of the heart. Transthoracic echocardiography shows cardiac malformation: Fallot tetralogy. The precocious diagnosis is possible by prenatal ultrasound examination after 12th week of pregnancy. The surgical treatment remain the only hope for these neonates. It's results depends on the associated malformations and the neonatal complications especially the infections. The prognosis remains poor in spite of the progress of surgical techniques.

[Percutaneous mitral commissurotomy: how can it be made simpler and more efficacious?]. / La commissurotomie mitrale percutanée: comment faire plus simple et plus efficace?

The authors report the results of a simplified method of percutaneous mitral dilatation from 936 procedures. This method introduced in our service since 1997 consists in progressively increasing diameters inflation of Inoué balloon, using echographic control and without any arterial procedure. Our population consists on 683 women (73%) and 253 men with a mean age 34 +/- 15 years (extremely 9 and 80 years) with subgroups composed of 26 pregnant women, 32 children less than 17 years, 59 restenosis after closed heart mitral commissurotomy, 14 restenosis after open heart mitral commissurotomy, 74 restenosis after percutaneous mitral commissurotomy, 5 tricuspid and mitral dilatation, 2 coronary and mitral dilatation (with stenting), 2 patients with a history of surgical mitral valvuloplasty for pure mitral regurgitation. The mitral area passed from 1 +/- 0.2 cm2 to 2.1 +/- 0.1 cm2. A surgical mitral regurgitation was observed in 3 cases. The time of fluoroscopy was 6.4 +/- 3.3 min. The hole time procedure was 19 +/- 9 min. The delay of hospitalisation was one day in 97% of patients. The decreased cost was about 20%. The patient comfort and the large diffusion of this method predicts a good future of this simplified technique.

[Evolution after 5 years of percutaneous pulmonary valvulotomy: report of 47 cases]. / Evolution a plus de 5 ans de la valvulotomie pulmonaire percutanée: a propos de 47 observations.

47 patients aged from 2 to 59 years affected by valvular congenital or mixed pulmonary stenosis including three fallot trilogies and one patient with right congestive cardiac failure are treated by percutaneous pulmonary valvulotomy between october 1986 and december 1990. All patients have been controlled with a mean follow-up of 6.5 +/- 1.1 years. The total gradient rate between pulmonary artery and right ventricule decrease from 112 +/- 55 mm Hg to 20 +/- 8 mm Hg on the last control with disappearance of infundibular inflammation and inter auricular shunt in all the concerned cases. We observe the regression of right cardiac failure symptoms with disappearance of tricuspid insufficiency in the cases of advanced pulmonary stenosis with right ventricular dysfunction. Percutaneous pulmonary valvulotomy by its simplicity and harmlessness, its long term efficiency is a good method of treatment of pure valvular or mixed pulmonary stenosis.

[Percutaneous mitral commissurotomy: simplified new method]. / La commissurotomie mitrale percutanée: nouvelle méthode simplifiée.

We report a new simplified method of mitral dilatation done on 146 patients. This technique use the Inoue balloon with progressive diameters under ultrasonographic control, avoiding the arterial part of the dilatation. The population include 9 pregnant women, 13 children, 13 with restenosis and closed heart and 12 restenosis after dilatation. Mean age is 32 +/- 16 years (9 to 72) and sex ratio 3.7 (114 F/32 M). Three groups are individualized according to histopathologic exam of mitral structure, group I (26%) concern good indication and III (32%) bad indication for this technique, group II (42%) contain intermediate indications. Commissurotomy increase the mean mitral square for 0.2 to 1.9 +/- 0.1 cm_. We observe 3 cases of chirurgical mitral insufficiency needing remplacement recruited for 2 patients from the group III. Mean fluoroscopic exposition time is 5.2 +/- 3.3 mn and procedure duration 18 +/- 11 mn. Hospitalisation duration is one day for 95% of the patients. This method remaining simple, efficient and safe permit a gain in time of 70% with a good comfort for patient and a return to work on the 4th day.