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La présente étude propose d’analyser les caractéristiques spatio-temporelles de la voix de patients francophones présentant une immobilité laryngée suite à une opération de la glande thyroïde. Il s’agit ici d’évaluer les conséquences de l’immobilité laryngée sur le timing des articulateurs, à l’aide d’un corpus de logatomes (ou de séquences VCV). Notre investigation, bien qu’acoustique, entend analyser, le Voice Onset Time les différents indices articulatori-acoustiques qui peuvent être observés à partir d’un signal acoustique continu, et ainsi remonter aux configurations articulatoires (Abry et al., 1985). Une attention particulière sera donc accordée aux différentes perturbations temporelles qu’une immobilité laryngée peut provoquer sur la voix des patients, grâce à l’étude de la réorganisation temporelles des paramètres retenus. Notre étude se veut longitudinale puisque la voix des patients est enregistrée lors de différentes phases post-opératoires (post-opératoire 2, 3 et 4), ce qui devrait nous permettre de mettre au jour, non seulement les perturbations provoquées par l’immobilité laryngée, mais également les réajustements que les patients pourraient mettre en place au cours du temps et de leur rééducation orthophonique. Seul l’intervalle du VOT pour les occlusives sonores a été modifié. Pour les occlusives voisées, la transition CV implique uniquement un changement d’un état obstrué de conduit vocal à un état suffisamment dégagé de celui-ci pour permettre l’apparition d’une structure formantique claire et stable. En revanche, pour les occlusives non voisées, cette transition CV exige, outre le changement d’état du conduit vocal, une modification de la configuration de la glotte d’une position ouverte pour la consonne non voisée à une position fermée pour la voyelle subséquente. En conséquence, en raison de difficultés de maintien de vibrations laryngées, le VOT, qui est un indice de voisement, est alors généralement plus long pour les occlusives voisées que celles produites par les locuteurs contrôles. La durée du VOT de Klatt (1975) des occlusives voisées des patients reste toutefois quantitativement distincte des occlusives non voisées. En conséquence, la durée de la tenue consonantique des patients se voit également allongée dans les phases d’enregistrement précoces.

The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

The development of acute myeloid leukaemia after low-dose radioiodine therapy and its presentation as a myeloid sarcoma of the uterine cervix are both rare events. We report a case of acute myeloid leukaemia revealed by a myeloid sarcoma of the uterine cervix in a 48-year-old woman, 17 months after receiving a total dose of 100 mCi 131I for papillary thyroid cancer. A strict hematological follow-up of patients treated with any dose of 131I is recommended to accurately detect any hematological complications which might have been underestimated. Unusual presentations, such as chloroma of the uterine cervix, may reveal myeloid malignancy and should be kept in mind.

The presence of a metastatic papillary carcinoma in the neck is presumptive evidence of a primary thyroid neoplasm since neck metastases of other primary tumors are uncommon. Immunohistochemical studies may be required to diagnose these metastases. We report 2 cases in which an unrelated tumor mimicked a thyroid malignancy. Both patients had been referred for evaluation of enlarged lymph neck nodes without any other symptoms. In both cases, a lymph node biopsy identified a metastatic papillary adenocarcinoma that was believed to be consistent with a thyroid primary. Thyroidectomy was not performed in either case. Further investigations led to the diagnosis of other primary tumors that were unrelated to the thyroid; the unrelated primaries were an ovarian serous tumor in one patient and a papillary renal cell carcinoma in the other.

Surgery, which remains a conventional treatment of breast tumors, may induce the secretion of growth factors that support angiogenesis and wound healing. These factors are suspected to trigger carcinoma cell division and promote tumor relapse. We addressed this question by culturing breast cancer cell lines in the presence of wound fluid harvested after surgery.Wound fluids were collected from patients who underwent either breast reconstruction, tumor resection, or tumor resection after neoadjuvant chemotherapy. MCF-7 (estrogen receptor (ER)+/progesterone receptor (PgR)+, HCC1937 (ER/PgR-, human epidermal growth factor receptor/neuralized (HER2/neu)-) and MCF-10A (used as a negative control) cell lines were grown in culture media supplemented with wound fluids.Wound fluids drained during the three categories of procedures significantly stimulated the proliferation of MCF-7 and HCC1937 cells in a similar manner.This stimulatory effect on tumor cell proliferation could be attenuated by therapeutic targeting against growth factors and inflammation processes in order to avoid tumor relapse.

As a prerequisite to nonviral gene therapy approaches of ovarian carcinoma, we evaluated the possibility of transfecting established tumor cell lines (SKOV3, IGROV1) as well as primary mesothelial and tumor cells by various polyethylenimine (PEI) derivatives. Several PEI-based vectors were able to effectively transfect these cells, as shown by high luciferase expression levels (10(8) to 10(9) relative light units per milligram of cell protein) that corresponded with 25-50% of green fluorescent protein-positive cells after 24 hours. However, unpredictable differences were observed among the vectors and cell types that a posteriori justified the screening procedure. We also showed that cells that were not transfected after the first experiment remained transfectable in a subsequent transfection experiment to a level similar to that of the initial population. This experiment does not support the emergence of a transfection-resistant cell population and opens the door to multiple therapeutic gene deliveries. Although efficacy and cell targeting still remain to be improved, PEI derivatives appear to be promising molecules for the development of nonviral gene therapy of ovarian carcinoma.

Le présent travail est une étude acoustique de quelques caractéristiques spectrales de voyelles soutenues de patients souffrant de paralysies récurrentielles mais également de patients pour lesquels le diagnostic ORL n'a pas révélé de paralysie mais dont la voix est altérée après une opération de la glande thyroïde. Les conséquences de l'opération chirurgicale sont évaluées dans le but d'identifier les différentes perturbations que cette opération peut provoquer mais également afin de mettre au jour les possibles stratégies de compensations et/ ou réajustements que le patient peut mettre en place seul ou à l'aide d'une rééducation orthophonique. Notre étude se veut longitudinale puisque les patients sont enregistrés lors de différentes phases post-opératoires.

Our objective was to assess the global cost of the sentinel lymph node detection [axillary sentinel lymph node detection (ASLND)] compared with standard axillary lymphadenectomy [axillary lymph node dissection (ALND)] for early breast cancer patients.We conducted a prospective, multi-institutional, observational, cost comparative analysis. Cost calculations were realized with the micro-costing method from the diagnosis until 1 month after the last surgery.Eight hundred and thirty nine patients were included in the ASLND group and 146 in the ALND group. The cost generated for a patient with an ASLND, with one preoperative scintigraphy, a combined method for sentinel node detection, an intraoperative pathological analysis without lymphadenectomy, was lower than the cost generated for a patient with lymphadenectomy [€ 2947 (σ = 580) versus € 3331 (σ = 902); P = 0.0001].ASLND, involving expensive techniques, was finally less expensive than ALND. The length of hospital stay was the cost driver of these procedures. The current observational study points the heterogeneous practices for this validated and largely diffused technique. Several technical choices have an impact on the cost of ASLND, as intraoperative analysis allowing to reduce rehospitalization rate for secondary lymphadenectomy or preoperative scintigraphy, suggesting possible savings on hospital resources.

Thyroid surgeries associated with an elevated incidence of recurrent laryngeal nerve (RLN) injury are considered high-risk thyroidectomies. These high-risk operations include surgery for thyroid cancer, Graves disease, and recurrent goitre. In addition, the size of the goitre is an important risk factor for RLN injury.In our retrospective study, we tried to evaluate the role of intraoperative neuromonitoring of RLN specifically in high-risk thyroid surgery with 421 nerves at risk.Thyroid surgeries in our study were done by experienced surgeons in a high-volume provider centre.The overall percentage of RLN injury was 8.8% in the monitored group in comparison with 9.1% in the unmonitored group. The percentage of permanent nerve palsy in the monitored group was 3.9% of nerves at risk in comparison with 3.8% in the unmonitored group. No statistically significant difference was found between groups.Routine visual identification of the nerve by meticulous dissection is the best method to avoid RLN injury. The benefit of RLN neuromonitoring could be further assessed by performing a multicentre prospective study to compare the role of RLN neuromonitoring in high-risk thyroid surgeries.

Radiation-induced small bowel injury is a limiting factor to postoperative tumoricidal pelvic doses exceeding 4500 to 5000 cGy. Data from a review of the literature showed the inadequacy of medical measures and the bad reproducibility of radiation therapeutic attempts to decrease small intestine damage. Recent studies cited the benefit of a polyglycolic acid mesh to create an absorbable intestinal sling and suspend the loops above the pelvic radiation field. In 60 cases of gynecologic and rectal malignancies with a surgical intestinal morbidity of 8.3% (5 cases), the rate of radiation enteritis was 7% (4 cases) with an average follow-up of 17.8 months (range, 1 to 57 months). The quality of small intestinal elevation and the absence of loop herniation were demonstrated by the barium index. Magnetic resonance imaging was used for checking the polymer polyglycolic acid mesh position and its complete resorption at the third to fifth postoperative month. The authors conclude that this new procedure is safe in selected patients with high pelvic recurrence risk after optimal surgery, in residual disease after debulking surgery, or at the time of exploration for unresectable pelvic tumors. Clinical studies are ongoing to evaluate the long-term efficacy of this surgical technique to prevent chronic radiation enteropathy and improve locoregional control in advanced pelvic carcinomas.

1Centre Leon Berard, Lyon; 2FNCLCC, Paris; 3Institut Bergonie, Bordeaux; 4Centre Jean Perrin, Clermont-Ferrand; 5Centre Paul Papin, Angers; 6CHU Bretonneau, Tours; 7Centre Alexis Vautrin, Nancy; 8Centre Henri Becquerel, Rouen; 9CHU, Angers; 10CHU, Hopital Arnaud de Villeneuve, Montpellier; 11Centre Paul Strauss, Strasbourg; 12Clinique Sainte-Catherine, Avignon, France British Journal of Cancer (2001) 84(Supplement 2), 31–36 © 2001 FNCLCC doi: 10.1054/ bjoc.2001.1760, available online at http://www.idealibrary.com on

Patent Blue V (PBV), a dye used clinically for sentinel lymph node detection, was mixed with human serum albumin (HSA). After binding to HSA, the fluorescence quantum yield increased from 5 × 10(-4) to 1.7 × 10(-2), which was enough to allow fluorescence detection and imaging of its distribution. A detection threshold, evaluated in scattering test objects, lower than 2.5 nmol × L(-1) was obtained, using a single-probe setup with a 5-mW incident light power. The detection sensitivity using a fluorescence imaging device was in the µmol × L(-1) range, with a noncooled CCD camera. Preclinical evaluation was performed on a rat model and permitted to observe inflamed nodes on all animals.

Abstract #207 BACKGROUND. Pure tubular carcinoma (PTC) is a favourable histologic subtype of breast cancer with a low rate of lymph node involvement. This study was initiated to assess the sentinel lymph node (SLN) detection rate and the rate of axillary involvement. METHODS. Inclusion criteria were a PTC (tubular component >90%) core biopsy diagnosed breast cancer smaller than 20 mm, and a homolateral clinically axilla free of nodal involvement. Patients underwent a SLND alone or with an Axillary level I-II Lymphadenectomy (AL). An AL was performed in the case of the learning curve, or in the case of SLN involvement – macrometastases, micrometastases or isolated cells - or in the case of mapping failure. RESULTS. From January 1999 to December 2006, 234 patients were selected from 9 French Comprehensive Cancer Centers. Median tumour size was 9.59 mm (1-22) . The SLN detection rate was 97.9% (229/234). The median number of SLN harvested was 2.15 (range 0-8). Respectively the frequency of macrometastasis - >2mm - was 2.6% (6/229), micrometastasis was 6.5% (15/229) and isolated cells was 0.8% (2/229). There were no false negative cases among the 24 patients with a systematic complementary axillary lymphadenectomy performed in the case of a learning curve. Axillary macrometastasis were found in non sentinel lymph nodes after completed axillary lymphadenectomy in 3 / 6 patients with macrometastasis, in 1/15 patients with micrometastasis and in 0/2 patients with isolated cells. There was no lymph node involvement for tumour size < 10mm. Pathological tumor size >10 mm was statistically correlated to the risk of axillary involvement (p=0.0223). CONCLUSIONS. This study confirms that in the case of PTC ≤ 20mm SLN detection is feasible and the risk of lymph node involvement very low. In the case of PTC Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 207.