Osteosarcomas of the mandible: multidisciplinary management of a rare tumor of the young adult a cooperative study of the GSF-GETO, Rare Cancer Network, GETTEC/REFCOR and SFCE.

BACKGROUND: Mandibular osteosarcomas (MOS) mostly affect young adults. Their treatment is extrapolated from that of extragnathic osteosarcomas. MATERIAL AND METHODS: A retrospective multicooperative group study was conducted to determine the impact of chemotherapy, adjuvant radiation therapy and surgery on outcomes and to identify prognostic factors. This ethical committee-approved study included a centralized review of histology slides and operative reports. RESULTS: Of 111 patients, 58.6% were male, median age 35 years (13%, ≤18 years). Histology was osteoblastic, chondroblastic, fibroblastic, conventional not otherwise specified and others in 39.6%, 30.6%, 8.1%, 12.6% and 8.0%, respectively. Pathological World Health Organisation grades were low, intermediate and high grade in 6.4%, 11.8% and 81.8%, respectively. Surgery was carried out for 94.5% of patients. Neoadjuvant chemotherapy (mixed protocols) was carried out in 93.1% of patients. Postoperative chemotherapy and radiotherapy were carried out in 54.7% and 23.8%, respectively. Median follow-up was 59.6 months (range). Five-year local control, metastasis-free, disease-free and overall survival rates were 64.6%, 68.9%, 53.2% and 69.2%, respectively. Survival was significantly associated with age, tumor size and surgery. Wide surgery with clear margins and free flap reconstruction was the strongest prognostic factor. Neoadjuvant chemotherapy improved disease-free and metastatic-free survival and increased clear margins rates from 50% to 68%. Intermediate grades behaved like high grades in terms of metastatic-free and disease-free survival. CONCLUSION: This homogeneous series is the largest to date and emphasizes the major impact of clear margins and multidisciplinary management. Neoadjuvant chemotherapy improves disease-free survival and should be recommended for both high and intermediate grade MOS.

[Artificial nutrition and preoperative fasting]. / La nutrition artificielle et le jeûne préopératoire.

Preoperative fasting is a currently adopted measure since Mendelson's report pertaining to aspiration pneumonia as a cause of death following general anesthesia. From a metabolic point of view fasting is detrimental because surgery in itself causes a state of hypercatabolism and hyperglycemia as a result of insulinresistance. Preoperative fasting has become almost obsolete in certain elective surgical procedures. In these cases the use of clear liquids is now well established and this paper focuses on the safe use of clear fluids, postoperative insulinresistance, patient comfort and postoperative outcome as well as its effect on the length of stay.

Coexistence of renal malakoplakia and myelodysplastic syndrome.

Malakoplakia is a protean systemic chronic granulomatous disease that usually targets the genito-urinary system and most particularly the bladder. Only in rare occasions do the kidneys get involved. Myelodysplastic syndrome is a heterogeneous clonal haematopoietic disorder characterised by either a hyper- or hypocellular bone marrow dysmyelopoiesis and peripheral blood pancytopenia. The synchronous association of these two unrelated disorders has never been reported. We report a 62-year-old woman who initially developed vague, relapsing gastrointestinal symptoms synchronous with renal malakoplakia and myelodysplastic syndrome.

[Forced delivery instead of postmortem cesarean section]. / Accouchement forcé en lieu et place de l'opération césarienne post mortem.

The Lex Regia stipulated that no pregnant women shall be buried unless the child has been removed from her womb. The post mortem caesarean delivery was upheld till 1861 by the majority of obstetricians but nevertheless, anterior to the XIXth century, in 1729, Delamotte practiced delivery in the agonising patient in the absence of labour in view to bypass the cesarean section in hope of better child survival. This article describes the beginning of forced ante mortem delivery upon post mortem cesarean section, which contributed to a decrease in child mortality.

A late complication of percutaneous radial artery cannulation.

Radial artery pseudoaneurysms occurring as a late complication of percutaneous radial artery cannulation are rare, while those which are infected are exceptional. Known risk factors are age-related with patients being in their seventies and onwards, the duration of the radial artery catheter and staphylococcal catheter-related infections. We report the case of an 82-year-old patient who developed a mycotic radial artery pseudoaneurysm as a late complication of arterial catheterization.

[Do not resuscitate orders in the intensive care setting]. / L'ordre de ne pas réanimer aux soins intensifs.

Even if Belgium (2002), The Netherlands (2002) and Luxemburg (2009) are the first three countries in the world to have legalized active euthanasia, there still is not a law on the do not resuscitate concept (NTBR or DNR). Nevertheless, numerous royal decrees and some consensus as well as advice given by the Belgian Medical Council, hold as jurisprudence. These rules remain amenable to change so as to suite the daily practice in intensive care units. This article describes the actual Belgian legal environment surrounding the intensive care specialist when he has to take such decisions.

[Cadavers and mummies as therapeutic means]. / Le cadavre et la momie utilisés à des fins thérapeutiques.

Sickness befallen onto him, man found that plant and animal derivatives invigorated him. Thereafter, he found a therapeutic benefit in using man as a means of self cure and especially, dead man from violent death. The foam of the skull of cadaver was an excellent antiepileptic as well as blood coming out from a freshly decapitated man. By applying on diseased parts of his body, so as to get rid of inflammation or infection, cadaver's hands were used against tumors of all kinds. Dead human skin were processed into belts and used therein for helping delivery of parturition women. The mummy must be blackish, foul smelling and hard. Those who were whitish, odorless and powder-like, were unfit for use. Mummy powder applied to the nose would stop nose bleeding. Ambroise Paré (1510-1590) was an adversary of those practices.

Plasma levels of ICAM-1 and circulating endothelial cells are elevated in unstable types 1 and 2 diabetes.

OBJECTIVE: To investigate the expression and release of vascular cell-adhesion molecule (VCAM)-1, intercellular adhesion molecule (ICAM)-1, endothelial leukocyte adhesion molecule (ELAM)-1 and von Willebrand factor (vWF), as well as circulating endothelial cells (CEC) and circulating endothelial progenitor cells (CEPC), as markers of endothelial dysfunction in uncontrolled, well controlled types 1 and 2 diabetic patients and non diabetic patients. METHODS: In this observational trans section study, soluble adhesion molecules concentrations were measured by enzyme linked immunosorbent assays and flow cytometry to detect circulating cells in 49 patients, stratified in 3 groups: G1: uncontrolled types 1 and 2 diabetic patients (n=16); G2: well controlled diabetic (types 1 and 2) patients (n=13); and G3: non diabetic patients (n=20), of whom a blood sample was obtained on admission. RESULTS: ICAM-1 increased significantly in uncontrolled versus well controlled and non diabetic patients (721 vs. 702.45 vs. 473.46 ng/ml, p=0.016). In unstable diabetic patients, CEC were higher than in the well controlled ones (7.75 vs. 4.3/ml, p=0.386) whereas CEPC were lower in unstable diabetics (56.5 vs. 72/ml, p=0.068). CONCLUSIONS: This study showed a continuous rise in ICAM-1 and CEC levels as stable, well controlled diabetic patients shift towards decompensation. In unstable diabetic patients, the relationship between CEC and CEPC can be represented as [CEC] alpha 1/[CEPC].

[Medicinal leeches]. / Les sangsues.

Leeches are hermaphroditic and hematophagous annelids. One important medical species, Hirudo medicinalis, comes from hirudiniculture of fresh water pools. Thanks to their three mandibles with some 300 teeth on their anterior muscular sucker, they easily grab to tissues and by secreting their saliva containing numerous powerful enzymes, such as hyaluronidase, collagenase and inhibitors of platelet aggregation and coagulation, like hirudin, allow blood sucking. Once they are full of blood (up to 15 g of blood), they detach themselves from their prey. Used ever since the 18th Egyptian Dynasty, leeches became famous during the first part of the XIXth century, thanks to a French physician, François Joseph Victor Broussais, known to his adversaries as the "vampire of medicine" for treating various conditions such as phlebotomy, laryngitis, ocular problems, obesity, mental disorders, etc. Overfishing, therapeutic failures and most particularly, the emergence of hygiene, brought the decline of living leeches. In 1884, an extract of leeches was obtained--hirudin and henceforth used. Nowadays, leeches are still used in microsurgery to enhance the venous circulation in finger reimplantation or skin flap transposition. Hirudin is synthesized through recombinant DNA technology and molecules such as lepirudin and desirudin are available on the market as anticoagulant.

Lipofibromatous hamartoma of the median nerve. Three case reports.

Nervous lipofibromatous hamartoma is a rare tumour-like condition involving the peripheral nerves, whereby the epineurium and perineurium are enlarged and distorted by excess fatty and fibrous tissues that infiltrate between and around nerve boundaries. The median nerve is much more likely than other nerves to develop a hamartoma with a predilection for the carpal tunnel. In this article, we describe three cases of lipofibromatous hamartoma of the median nerve and discuss its management.