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Myelolipoma is a rare mesenchymal tumor consisting of adipose tissue and hematopoietic cells. Found usually in the adrenal region, however, few cases have been reported in extra-adrenal regions, most frequently in the presacral region. It is important to recognize such tumor, as it can attain massive size and causes pressure symptoms, and needs to be differentiated from malignant tumors, including liposarcomas. Although CT and MRI can suggest a diagnosis of myelolipoma, these are not conclusive. The hematopoietic cells are enhanced by a Tc-albumin nanocolloid scintigraphy and help to distinguish myolipoma from other entities.

Graves' disease may be associated with thyroid cancer, particularly differentiated thyroid cancer. Medullary thyroid cancer (MTC) is less common. The occurrence of sporadic MTC in Graves' disease in the presence of a RET proto-oncogene has never been reported.: A 63-year-old woman was referred for Graves' disease. A thyroid ultrasound disclosed five nodules, one of which was classified as Eu-Tirads 5 with a size of 6.7 × 6.5× 11 mm. Fine needle aspiration was reported as Bethesda class IV follicular neoplasm of a Hürthle cell subtype. Calcitonin level was found to be elevated. A total thyroidectomy confirmed the diagnosis of MTC and a bilateral cervical lymphadenectomy was performed, with four lymph nodes being infiltrated by MTC. Genetic testing revealed a M918T mutation in the RET proto-oncogene.: MTC may occur in Graves' disease, especially if a nodule is present. In this case, genetic testing should always be performed even if MTC is sporadic. Increased incidence of thyroid cancer in autoimmune thyroid diseases, as well as the link existing between autoimmunity, inflammation and carcinogenesis, leads us to hypothesize that the association here reported is not coincidental.

After extended hepatectomy, hepatocyte proliferation proceeds sinusoidal endothelial cell (SEC) remodeling causing a transient perturbation of the lobular architecture with proliferating hepatocytes forming avascular, hypoxic, clusters. Hypoxia is, thus, considered at the origin of liver dysfunction in SFSS-hepatectomy. Recently, we showed that activation of hypoxia sensors in an upfront SFSS-hepatectomy surged an early angiogenic switch and preserved the sinusoidal architecture with a favorable impact on survival.

To assess outcomes among patients undergoing total pancreatectomy (TP) including predictors for complications and in-hospital mortality. Current studies on TP mostly originate from high-volume centers and span long time periods and therefore may not reflect daily practice. This prospective pan-European snapshot study included patients who underwent elective (primary or completion) TP in 43 centers in 16 European countries (June 2018-June 2019). Subgroup analysis included cut-off values for annual volume of pancreatoduodenectomies (<60 vs. ≥60). Predictors for major complications and in-hospital mortality were assessed in multivariable logistic regression. In total, 277 patients underwent TP, mostly for malignant disease (73%). Major postoperative complications occurred in 70 patients (25%). Median hospital stay was 12 days (IQR 9-18) and 40 patients were readmitted (15%). In-hospital mortality was 5% and 90-day mortality 8%. In the subgroup analysis, in-hospital mortality was lower in patients operated in centers with ≥60 pancreatoduodenectomies compared < 60 (4% vs. 10%, p = 0.046). In multivariable analysis, annual volume < 60 pancreatoduodenectomies (OR 3.78, 95%CI 1.18-12.16, p = 0.026), age (OR 1.07, 95%CI 1.01-1.14, p = 0.046), and estimated blood loss ≥2L (OR 11.89, 95%CI 2.64-53.61, p = 0.001) were associated with in-hospital mortality. ASA ≥3 (OR 2.87, 95%CI 1.56-5.26, p = 0.001) and estimated blood loss ≥2L (OR 3.52, 95%CI 1.25-9.90, p = 0.017) were associated with major complications. This pan-European prospective snapshot study found a 5% in-hospital after TP. The identified predictors for mortality, including low-volume centers, age, and increased blood loss, may be used to improve outcomes.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) allows extended hepatectomy in patientswith an extremely small future liver remnant (FLR). Current rodent models of ALPPS do not include resection resulting ininsufficient-for-survival FLR, or they do incorporate liver mass reduction prior to ALPPS. Differences in FLR volume andsurgical procedures could bias our understanding of physiological and hemodynamic mechanisms. We aimed to establish arat ALPPS model with minimal FLR without prior parenchymal resection. In rodents, the left median lobe (LML) represents10% of total liver. Partial hepatectomy (PHx) sparing LML and pericaval parenchyma represents our reference 87%resection. Thefirst step in the procedure is either portal vein ligation (PVL) corresponding to ligation of all but the LMLportal branches, or PVL with transection between the left and right median lobe segments (PVLT), and is defined as ALPPSstage-1. Second, ligated lobes were removed: PVL-PHx represents a conventional 2-stage hepatectomy, while PVLTfollowed by PHx is a strict reproduction of human ALPPS. In Group A, liver hypertrophy was analyzed after PVL (n=38),PVLT (n=47), T (n=10), and sham (n=10); In group B, mortality and FLR hypertrophy was assessed after PHx (n=42),Sham-PHx (n=6), PVL-PHx (n=37), and PVLT-PHx (n=45). In group A, PVLT induced rapid FLR hypertrophycompared to PVL (p< 0,05). Hepatocyte proliferation was higher in PVLT remnants (p< 0,05). In group B, PHx had a 5-daymortality rate of 84%. Sham operation prior to PHx did not improve survival (p=0.23). In both groups, major fatalitiesoccurred within 48 h after resection. PVL or PVLT prior to PHx reduced mortality to 33.3% (p=0,007) or 25% (p=0.0002) respectively, with no difference between the 2 two-stage procedures (p=0.6). 7-day FLR hypertrophy was higherafter the PVLT-PHx compared to PVL-PHx and PHx (p=0.024). Our model reproduces human ALPPS with FLR that isinsufficient for survival without liver

Excessive portal hypertension with compensatory arterial constriction of the future liver remnant (FLR) is considered the main cause of SFSS after major hepatectomy. ALPPS combines portal vein ligation and parenchymal transection to obtain rapid hypertrophy of FLR for patients needing marginal hepatectomy, with high risk of postoperative SFSS. This procedure sets the FLR in the same hemodynamic portal conditions as in SFSS, and yet, patients survive, and obtain boosted FLR hypertrophy. [...]

To assess the role of laparoscopic ultrasound (LUS) as a substitute for intraoperative cholangiography (IOC) during cholecystectomy.

Typical presentation of subacute thyroiditis (SAT) is an anterior neck pain radiating up to the jaw and ear, often associated with asthenia and fever. Biology shows hyperthyroidism and inflammation. The thyroid uptake is low at scintigraphy. However, the clinical presentation of SAT may be misleading. We report two cases of SAT whose initial manifestation was a painful thyroid nodule suspected of malignancy. In both cases, ultrasound feature was a heterogeneous, hypoechoic, ill-defined area with a low vascularization on colour Doppler. These areas were interpreted by radiologist as nodules. Surgery was then considered. Such a presentation should be known by clinicians to prevent unnecessary surgery.

Aim: A fair to moderate concordance in grading of the total mesorectal excision (TME) surgical specimen by local pathologists and a central review panel has been observed in the PROCARE (Project on Cancer of the Rectum) project. The aim of the present study was to evaluate the difference, if any, in the accuracy of predicting the oncological outcome through TME grading by local pathologists or by the review panel. Method: The quality of the TME specimen was reviewed for 482 surgical specimens registered on a prospective database between 2006 and 2011. Patients with a Stage IV tumour, with unknown incidence date or without follow-up information were excluded, resulting in a study population of 383 patients. Quality assessment of the specimen was based on three grades including mesorectal resection (MRR), intramesorectal resection (IMR) and muscularis propria resection (MPR). Using univariable Cox regression models, local and review panel histopathological gradings of the quality of TME were assessed as predictors of local recurrence, distant metastasis and disease-free and overall survival. Differences in the predictions between local and review grading were determined. Results: Resection planes were concordant in 215 (56.1%) specimens. Downgrading from MRR to MPR was noted in 23 (6.0%). There were no significant differences in the prediction error between the two models; local and central review TME grading predicted the outcome equally well. Conclusion: Any difference in grading of the TME specimen between local histopathologists and the review panel had no significant impact on the prediction of oncological outcome for this patient cohort. Grading of the quality of TME as reported by local histopathologists can therefore be used for outcome analysis. Quality control of TME grading is not warranted provided the histopathologist is adequately trained., SCOPUS: ar.j, FLWIN, info:eu-repo/semantics/published

L’environnement et le retour du géographique… Les textes ici rassemblés jalonnent un itinéraire épistémologique et méthodologique de long cours, bien individualisé et constamment balisé dans le champ indéfini de l’environnement. Sur les franges mouvantes et floues des sciences de la société et des sciences de la nature. À partir d’une géographie enrichie par les apports des disciplines voisines et mise en situation dans différentes configurations interdisciplinaires. Les objets étudiés, milieux, territoires et paysages, à la fois naturels et sociaux, matériels et immatériels, toujours confus et discordants, sont (re)construits sous la forme de systèmes complexes et hybridés soumis à la pratique de terrains variés en France et à l’étranger. Les quatre chapitres de l’ouvrage suivent les principales étapes d’une progression dont le but est de donner, à travers territoires et temporalités, une nouvelle dimension géographique à l’environnement. - Au départ, il y a le Géosystème, concept naturaliste incluant a priori un sous-système anthropique ; - Autour du concept de Territoire sont développées une histoire et une archéologie de temps long qui enracinent les environnements dans leurs sociétés respectives ; - La notion de Paysage marque l’irruption du sensible dans le champ de l’environnement et l’indispensable prise en compte des représentations socio-culturelles ; – Le Géosystème-source, le Territoire-ressource et le Paysage-ressourcement fonctionnent comme trois entrées convergentes qui ouvrent trois voies interdépendantes, scientifiquement construites, dans un même espace géographique. L’environnement résulte du jeu de leurs interactions dans le temps comme dans l’espace. Le système tripolaire GTP ne se substitue à rien. Il remet en situation les indispensables études sectorielles. Son intérêt épistémologique et méthodologique est double : préserver la complexité-diversité de l’environnement, aider à surmonter la fausse coupure nature-société. Peut-être s’agit-il pou

BACKGROUND: Few studies about health-related quality of life (HRQoL) in patients with melanoma have expressed their results in terms of utilities or disability weights (DWs). Utilities are required for calculating quality-adjusted life years and therefore for cost-effectiveness analyses. DWs are useful to assess the burden of diseases through disability-adjusted life years. OBJECTIVES: To provide utilities and DWs regarding patients with melanoma. METHODS: The patients were classified into eight groups using four stages based on the 2009 American Joint Committee on Cancer stages, with each stage subdivided into treatment and remission phases. The EuroQoL Five Dimensions Five Levels (EQ-5D-5L) questionnaire was completed by the patients with melanoma to provide a mean utility for each group. In addition to this, the EuroQoL visual analogue scale (VAS) and a validated quality-of-life questionnaire dedicated to patients with melanoma [Functional Assessment of Cancer Therapy Melanoma (FACT-M)] were completed by the same patients in order to compare their results with the obtained utilities. DWs were obtained by calculating, for each patient, the difference between his/her utility and the corresponding sex- and age-specific population norm. RESULTS: A total of 395 questionnaire sets were completed. Utilities and DWs showed significant differences between follow-up groups. Treatment groups had similar utilities and DWs but these results were obtained during different treatment durations and therefore have different weights. The VAS and the FACT-M were found to be less sensitive. Nevertheless, the FACT-M identified some problems not found by the EQ-5D-5L questionnaire. CONCLUSIONS: The EQ-5D-5L questionnaire seems adequate to provide utilities and DWs in patients with melanoma. Lower HRQoL in female patients with melanoma is probably linked to lower HRQoL in the general population.