Evaluation of axillary involvement by ultrasound-guided lymph node biopsy: A prospective study.

OBJECTIVES: The primary aim of this prospective study was to evaluate the accuracy of pre-operative ultrasound (US) alone and associated with a fine needle aspiration cytology (FNAC) or a core needle biopsy (CNB) in the diagnosis of axillary node involvement in patient with breast cancer. The secondary study objective was to determine if this US±FNAC or CNB can lead to the adequate axillary surgery in cN0 and cN1 patient. METHODS: A total of 121 consecutive women with stage cT1 to cT2, cN0/cN1, invasive breast cancer were prospectively identified at our institution between February 2, 2013 and August 30, 2013. The sensitivity, specificity, VPP, NPV were calculated, with confidence intervals, using the definitive histological result of the sentinel node biopsy (SLNB) or axillary lymph node dissection (ALND) as the baseline. RESULTS: Twenty-seven CNB and 2 FNAC were performed. For the whole series, the sensitivity and the specificity of US alone were 48.7% [36-59%] and 89% [83-94%]. For US±FNAC or CNB, the sensitivity and the specificity were 35.9% [26-38%] and 98.8% [94-100%]. Seven women with cN1 clinical examination had SLNB, which permit to decrease the number of ALND of 16.3%. It would have avoided unnecessary SLNB, prompting immediate ALND in 9 patients with cN0 axillae, which means a reduction of SLNB of 8.6%. US±FNAC or CNB lead to the adequate surgery in 72.7% of cases. CONCLUSION: US±CNB or FNAC is also a relatively efficient and safe test and should be considered routinely. It allowed triaging patients to the well axillary surgery (SLNB or ALND).

[Critical organs and external irradiation in gynaecological cancers: can water be used as contrast agent to make easier the delineation of the small intestine?]. / Organes critiques et irradiation externe des cancers gynécologiques: l'eau peut-elle être utilisée comme produit de contraste pour faciliter la délinéation de l'intestin grêle?

PURPOSE: To validate the use of water as contrast agent for the delineation of the small intestine on the planning CT of external beam in patients treated with conformal radiotherapy for gynaecological tumours. PATIENTS AND METHODS: From March to September 2003, 20 patients received an external irradiation for a gynaecological carcinoma (13 with cervix carcinoma, seven with endometrial carcinoma) in the radiotherapy department of the Centre G.F. Leclerc of Dijon. The protocol of opacification of the small intestine consisted in administration of a "negative" contrast agent: water. The protocol commonly used for the bladder filling, i.e. absorption of 500 cm(3) of water from 60 to 30 min before the CT-scan, was applied for the evaluation of the visualisation of the small intestine in the 12 first patients (group I). For the last eight patients (group II), the absorption of the same amount of water was fractionated, every 10 min within half an hour before the start of the examination. RESULTS: The small bowel identification was possible in 100% of cases without any need of administration of a "positive" contrast agent. In overall, the identification of the small intestine was considered as easy in 14 patients (70%) and as difficult in two patients (10%). In group I, the delineation was considered as easy in 50% of cases, moderately easy in 33% of cases and none easy in 17% of cases. Conversely, no difficulty was encountered for the definition of the small bowel in all patients of group II. CONCLUSIONS: Water is an efficient "negative" contrast agent for the differentiation of the small bowel from the colon on the planning abdomino-pelvic CT. Nevertheless, the delineation was really made easier only when the fractionated protocol of water absorption within half an hour before CT was used.

Does background music in a store enhance salespersons' persuasiveness?

Background music has been studied as a key element of the store atmosphere in terms of its emotional effects; however, previous studies have shown also that music may have cognitive influence on consumers. How does music affect the salespersons' persuasive efforts within the store? To answer this question an experimental study was designed to assess the effects of four levels of arousing music conditions (no-low-moderate high arousing music). The level of pleasure of the musical pieces was controlled for. Music does not moderate significantly the effects of the salespersons on the intent to buy, but low and moderately arousing music (similarly low and moderately interesting musical pieces) does influence significantly the effects on the acceptance of the salesperson's arguments and the "desire to affiliate," i.e., to enter into communication.

Maximum and mean bladder dose defined from ultrasonography. Comparison with the ICRU reference in gynaecological brachytherapy.

The reference bladder dose for gynaecological intracavitary brachytherapy (BT), as defined by the ICRU 38 Report, is often criticised as it is seldom representative of the highest bladder dose nor it gives an idea of the area exposed to a significant dose. Since November 1990, ultrasound measurements are routinely made in order to determine the actual dose delivered to the bladder of each patient. The technique was as follows. (1) the bladder is filled up with 150-200 cm3 of sterile isotonic saline. (2) The intrauterine position of the tube is checked. (3) The bladder anatomy is controlled. (4) Points of measurements are identified: ICRU bladder reference, minimum distance between bladder mucosa, uterine tube and other similar measurements taken every 15 mm along the radio-active line. Maximum and mean doses are calculated at the sagittal plane. Measurements are performed by moving the transducer along the skin of the patient and included in the calculation of dose distribution. Doses delivered to each relevant point are compared. This enables determination to be made of the differences between the ICRU and the doses actually observed at the bladder wall with aid of ultrasonography. BT applications were checked in 58 patients (69 measurements). The method was feasible in all cases. The comparison between ICRU dose from orthogonal films and the ICRU dose from ultrasonography resulted in a 90% accuracy. The maximum and mean doses for utero-vaginal BT are higher than the ICRU dose in 75% of cases (range, 2-8). Measurements are now abandoned for vaginal applications as the ICRU dose only could be measured.(ABSTRACT TRUNCATED AT 250 WORDS)

[Four-year follow-up of thyrotoxic patients treated with antithyroid drugs bases on thyroid suppressibility-Prognostic value of the 20-min 131-I thyroid uptake (author's transl)]. / Traitement de l'hyperthyroïde par les antithyroïdiens de synthèse: valeur pronostique de la captation thyrïdienne précoce (recul de 4 an).

Out of 77 thyrotoxic patients treated with Carbimazole (30-15 mg/day) in combination with 1-triiodothyronine (75 micron/day) for 5-48 months applying 20-min 131I-thyroid uptake test at the end of treatment as a parameter for thyroid suppressibility, 39 cases (51%) have maintained euthyroid state for more than 4 years, while 20 (26%) relapsed within 3 months and the remaining 18 (23%) recurred within 6 years after antithyroid-drug (ATD) therapy. The predictable value of 20-min 131I-thyroid uptake was useful for distinguishing relapses from others, but there was no statiscally significant difference between recurrent cases and remittent ones. Since the negative correlation between the 20-min 131I-thyroid uptake and the recurrent phase was noted, the continuation of ATD therapy until the uptake reaches below 8% postpones this phase of recurrence.