Search

Objective The WHO recommends same-day sputum smear microscopy for the diagnosis of smear-positive tuberculosis (TB) in countries with high TB burden for earlier diagnosis and treatment, a cornerstone to prevent air-borne transmission. We aimed to compare the conventional strategy (sputum collection on three consecutive days) and the same-day strategy (hour h, h + 1, h + 2) in France, a country with low TB burden. Patients and methods Over a six-month period, all adult individuals presenting with presumptive smear-positive TB were eligible for the study, registered in https://clinicaltrials.gov/ ID ( NCT 02961569 ). Sputum specimens were collected three times the first day, then once on the second day and once on the third day. The concordance between the two strategies regarding smears and cultures were assessed. Results Of the 131 eligible individuals, 34 were given a TB treatment. Smears from hour h, h + 1, h + 2, day two and three were negative in 19 of these 34 patients. Positive smears were obtained in 15, 14, 15, 14, and 14 patients at hour h, h + 1, h + 2, on day two and three, respectively. Concordance regarding smear or culture was good, with Kappa 0.69 and 0.64, respectively. Conclusion The same-day strategy seems to be a good alternative to the conventional strategy.

Purpose Anterior or lateral interbody fusion is a treatment option for lumbar disc disease. A segmental change occurs after such surgery. This study was designed to evaluate the changes in the lumbar regional alignment after a single or two-level standalone anterior or lateral interbody fusion (ALIF or LLIF). Methods Data from patients referred to our institution between March 2013 and November 2015 for standalone ALIF or LLIF for low-grade isthmic spondylolisthesis or degenerative discopathy were retrospectively included in our analysis. Patients with a history of spinal fusion were excluded. Global and regional alignments were analyzed pre- and postoperatively. Pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), index segmental lordosis (ISL) and L4S1 lordosis were compared. Three groups according to the pelvic incidence (PI) (low, normal and high) were separately analyzed then compared. Results Forty-one women and 27 men (mean age was 46 years; range 25–66) were included. The mean follow-up was 10.8 (range 3–34 months). The patients were globally well balanced preoperatively and remained after surgery (SVA stagnated from 16.76 ± 28.42 mm to 15.97 ± 28.20 mm, P = 0.75). PT and LL did not vary. L4S1 lordosis, and ISL were significantly increased respectively from 30.56 ± 8.59 to 34.58 ± 7.47 (P = 0.0026) and from 5.94 ± 5.25 to 12.99 ± 5.87 (P Conclusion Despite effective changes in the segmental lordosis at the index levels, our findings suggest that one or two-levels standalone ALIF or LLIF had no effect on the global balance and the lumbar lordosis. The three groups behaved similarly, the regional lordosis was redistributed in a better harmony (L4S1/LL ratio went up from 55% to 61%, P = 0.01). Study type Retrospective study. Level of evidence 4.

Resume Introduction L’arthrodese intersomatique par voie anterieure ou laterale est une option therapeutique pour traiter les pathologies discales lombaires. Des modifications segmentaires surviennent au decours de ce type de chirurgie. Hypothese L’arthrodese lombaire un ou deux niveaux standalone permet une redistribution plus harmonieuse de la lordose lombaire. Methodes Nous avons recueilli les donnees des patients qui ont beneficie dans notre institution d’un ALIF ou LLIF un ou deux niveaux standalone entre mars 2013 et novembre 2015, pour un spondylolisthesis isthmique de bas grade ou une discopathie degenerative. Les patients aux antecedents de chirurgie rachidienne ont ete exclus. L’alignement global et regional ont ete analyses en preoperatoire et postoperatoire. La version pelvienne (PT), la pente sacree (SS), le Sagittal Vertical Axis (SVA), la lordose lombaire (LL), la lordose segmentaire du niveau index (ISL), et la lordose L4S1 ont ete compares. 3 groupes ont ete analyses separement puis compares, en fonction de l’incidence pelvienne (PI). Resultats Quarante et une femmes et vingt-sept hommes (âge moyen 46 ans – 25–66), ont ete inclus. La duree moyenne de suivi etait de 10,8 mois (3 a 34 mois). Les patients etaient bien equilibres dans le plan sagittal en preoperatoire, et le sont reste (le SVA est reste stable de 16,76 ± 28,42 mm a 15,97 ± 28,20 mm p = 0,75). La PT et la LL n’ont pas ete modifiees. La lordose L4S1 et l’ISL ont augmente de maniere significative respectivement de 30,56 ± 8,59 a 34,58 ± 7,47 (p = 0,0026) et de 5,94 ± 5,25 a 12,99 ± 5,87 (p Conclusion Notre etude suggere que l’ALIF et le LLIF un a deux niveaux en standalone ne modifient pas l’equilibre sagittal global des patients mais peuvent permettre de reorganiser la repartition de la lordose au sein du rachis lombaire, afin de la rendre plus harmonieuse (le ratio lordose L4S1/LL est passe de 55 % a 61 %, p = 0,01). Type d’etude Etude retrospective. Niveau de preuve scientifique Niveau 4.

Introduction L’infection par le SARS-CoV-2 peut mener à un syndrome de détresse respiratoire aigu dont la mortalité était estimée à 50 % au début de l’épidémie. Ces formes sévères étant significativement associées à un état d’hyperinflammation, et notamment à un niveau élevé d’interleukine-6, il a été proposé que cibler la voie de signalisation de cette interleukine majoritairement pro-inflammatoire, puisse réduire la mortalité de la COVID-19. Pour autant, un an après le début de la pandémie, la place de ces inhibiteurs, dont le Tocilizumab, un anticorps monoclonal dirigé contre le récepteur de l’interleuline-6, reste à déterminer. Patients et méthodes Cohorte exposé-non exposé en vie réelle, monocentrique et menée à l’hôpital Saint-Antoine, Paris, France, avant la mise en place de l’essai randomisé CORIMUNO-TOCI. Etaient inclus les patients de plus de 18 ans qui présentaient une forme modérée à sévère de COVID-19, selon la définition de l’OMS, et qui nécessitaient une oxygéno-requerance ≥ 4 L/min, associée à un syndrome inflammatoire biologique (CRP > 50 mg/L). Etaient exclus les patients qui portaient des contre-indications au Tocilizumab (antécédent de sigmoïdite ou de diverticulite, une cytolyse hépatique supérieure à 5 N, une allergie connue au Tocilizumab, ou une infection bactérienne active.) Par ailleurs, les patients qui étaient transférés en soins intensifs dans les premières 24 h après l’injection de Tocilizumab étaient exclus de notre étude, puisque ils étaient inclus dans une étude qui évaluait le Tocilizumab en réanimation. Les patients du groupe Tocilizumab recevaient une injection de 8 mg/kg (maximum 800 mg) de Tocilizumab associée aux soins courants et les patients du groupe soins courants ne recevaient que les soins courants. Pour assurer la comparabilité des deux groupes nous avons utilisé le score de propension. Notre critère de jugement principal était le délai de sevrage en oxygène. Les critères de jugement secondaire étaient : le transfert en soins intensifs, le besoin de ventilation mécanique, le décès toutes causes confondues, le décès au dixie jour, la durée d’hospitalisation ainsi que les scores composites intubation ou décès et transfert en soins intensifs ou décès. Résultats Cinquante patients ont été inclus dans le groupe Tocilizumab et 52 patients dans le groupe soins courants. L’âge moyen était de 68,9 ± 2 ans et 71 % des patients étaient des hommes. Les patients du groupe Tocilizumab étaient plus fréquemment diabétique (34 % vs 13 % ; p = 0,02), et avaient un niveau d’oxygène moyen plus élevé (9,1 L/min vs 6,8 L/min ; p = 0,0002). Les patients du groupe Tocilizumab avaient reçu plus de corticoïdes que les patients du groupe soins courants (53 % vs 6 % ; p

Resume Introduction L’attitude therapeutique dans la prise en charge des spondylolisthesis L5-S1 de haut grade reste controversee. La reduction du glissement, la correction de la cyphose lombosacree ainsi que la necessite d’un temps anterieur complementaire sont les points de debat actuels dans la litterature. L’objectif de cette etude est d’exposer les resultats cliniques et radiologiques a long terme d’une technique chirurgicale de reduction et d’arthrodese instrumentee par un temps posterieur unique. Materiel et methode Il s’agit d’une etude retrospective incluant tous les patients operes consecutivement par le meme operateur (D.C.) d’un spondylolisthesis L5-S1 a grand deplacement (grades 3, 4 et 5 de Meyerding). La technique chirurgicale consistait en une reduction de la cyphose lombosacree et une arthrodese posterolaterale par un temps posterieur unique, sans resection du dome sacre ni temps anterieur complementaire chez les adolescents et les adultes jeunes. Seuls les cas de ptose de l’adulte ont necessite une greffe intersomatique a l’aide d’un greffon tibial encastre. L’analyse des complications cliniques et des parametres radiologiques lombopelviens, ainsi que l’equilibre sagittal ont ete realises au plus long recul. Resultats Cinquante patients ont ete revus dans cette etude. L’âge moyen etait de 21 ans (DS : 11 ans) au moment de l’intervention. Le recul etait de 5,5 ans (±4,6). La reduction de l’angle lombosacre etait en moyenne de 25°, passant de 76° a 101° ( p p p p p = 0,1). Dans17 cas (34 %), un deficit neurologique radiculaire postoperatoire etait constate, sans sequelle au recul. Aucune lesion de la queue-de-cheval n’a ete observee. La fusion osseuse a ete obtenue chez 42 patients (84 %) en un temps chirurgical. Apres reprise par greffe intersomatique complementaire, aucune pseudarthrose n’a ete observee. Conclusion Un temps chirurgical posterieur unique est une solution therapeutique fiable dans le traitement des spondylolisthesis de haut grade de l’adolescent et de l’adulte jeune. Cependant, ce type de traitement n’est pas sans risque (deficit transitoire et pseudarthrose) et le patient doit en etre prevenu. Une greffe intersomatique complementaire peut etre reservee aux cas de ptoses avec reduction incomplete de la cyphose lombosacree chez l’adulte et aux cas de reprise pour pseudarthrose. Niveau de preuve Etude retrospective de niveau IV.

IntroductionTo date there is no consensus on therapeutic indications in adolescent idiopathic scoliosis (AIS) with curvature between 30° and 60° at the end of growth.ObjectiveThe objective of this study was to assess outcome in patients with moderate AIS.Material and methodsA multicenter retrospective study was conducted. Inclusion criteria were: Cobb angle, 30–60° at end of growth; and follow-up > 20 years. The data collected were angular values in adolescence and at last follow-up, and quality of life scores at follow-up.ResultsA total of 258 patients were enrolled: 100 operated on in adolescence, 116 never operated on, and 42 operated on in adulthood. Mean follow-up was 27.8 years. Cobb angle progression significantly differed between the 3 groups: 3.2° versus 8.8° versus 23.6°, respectively; P 35° (OR=4.278, P=0.002). There were no significant differences in quality of life scores.DiscussionPatients operated on in adolescence showed little radiological progression, demonstrating the efficacy of surgical treatment for curvature greater than 50°. Curvature greater than 40° was progressive and may require surgery in adulthood. Lumbar scoliosis showed greater potential progression than thoracic scoliosis in adulthood, requiring fusion as of 35° angulation.Level of evidenceIV, retrospective study.

The Scoliosis Research Society traveling fellowship was conceptualized in 1970, repeated in 1972, and, after a pause, restarted in 1993. International traveling fellows visiting North America first commenced in 2000 and have since alternated annually with the North American fellows. Although a senior fellow had always traveled with them, in 2012 the first senior international fellow traveled with the group. This year, the senior fellow was Daniel Chopin from the Neuro-Orthopedic Spine Unit, Lille University Hospital, France, and past Director of the Spine Center, Institut Calot Berck sur Mer (succeeding Dr. Cotrel). The junior fellows were Meric Enercan from the Florence Nightingale Hospital, Istanbul Spine Center, Turkey; J. Naresh-Babu from Mallika Spine Centre, Guntur, Andhra Pradesh, India; and Nasir A. Quraishi from the Centre for Spine Studies and Surgery, Queen's Medical Centre, Nottingham, UK. The host centers were initially suggested by Dr. Chopin, the senior fellow; after some minor tweaking and extensive planning from the Scoliosis Research Society office, the itinerary was confirmed. The researchers were to visit 7 centers in just over 3 weeks. All of the international fellows were going to have an extraordinary adventure although they had not met each other previously. As it turned out, the trip was indeed sensational—professionally stimulating and socially endearing. The following is a short report on this unforgettable experience.

Vaccination against influenza virus and Streptococcus pneumoniae is a global health priority and authorities, on the basis of recent publications, have recently updated French recommendations. The aim of this study was to describe the influenzae and pneumococcal vaccination's rate in an internal medicine ward.All patients consecutively hospitalized during a 10 week-period in an internal medicine ward were included. The reasons for non-vaccination and the impact of an educational program for corrective measures were reported.Overall, 198 consecutive patients were included; 93 (47%) were immunocompromised; 142 (71.2%) had an indication for pneumococcal vaccination and 171 (86.4%) for influenza vaccination but only 16.2% and 55% of them were vaccinated against these microorganisms, respectively. Prior pneumococcal vaccination was more frequently observed in immunocompromised patients than in non-immunocompromised patients (21.1 versus 6.4%; P=0.029), but no significant difference was observed for influenza vaccine. Corrective measures were initiated in 46 patients (39%), non-immunized against S. pneumoniae.These results underline the very low prevalence of pneumococcal vaccination rate in at-risk hospitalized patients, as compared with influenza, despite recent recommendations.

Resume Introduction L’augmentation de la duree de vie de la population et l’amelioration de la prise en charge chirurgicale et medicale des patients âges font que les interventions chirurgicales pour scolioses lombaires et thoraco-lombaires de l’adulte voient leur indication augmentees. Cependant, le rapport benefice/risque de ces interventions reste encore discute. Patients et methodes Nous avons revu 180 patients, d’âge moyen 63 ans avec un recul minimum de un an lors d’une etude retrospective, continue et multicentrique. Ont ete etudies le taux d’incidence des complications de l’intervention et les facteurs pouvant influencer la frequence de survenue de celles-ci a l’aide d’une etude uni et multivariee. Le risque de reintervention a ete etudie grâce a une analyse de survie selon une methode actuarielle. Resultats Au recul moyen de 4,5 ans, 79 patients (44 %) presentaient au moins une complication dont 32 % une complication grave. Les complications les plus frequentes etaient des complications mecaniques. Les facteurs de risque etaient la co-morbidite medicale, l’etendue de la zone de fusion et l’importance du desequilibre anterieur preoperatoire. Une re intervention etait necessaire pour 25 % des patients a un an et pour 50 % des patients a six ans. Discussion La litterature montre que le traitement chirurgical donne de meilleurs resultats fonctionnel que le traitement medical dans la prise en charge des deformations rachidiennes thoraciques et thoraco-lombaires du sujet de plus de 50 ans. L’analyse rationnelle de la deformation et de la co-morbidite doit permettre de diminuer le taux de complications de cette chirurgie. Niveau d’evidence IV.

Summary Introduction The increasing life expectancy of the population and the improvement in surgical and medical management of elderly patients mean that the indication for surgical treatment of adult lumbar and thoracolumbar scolioses has been extended. However the benefit/risk ratio of these procedures is still under debate. Materials and methods We reviewed 180 patients, mean age 63 years old with a minimum follow-up of 1 year in a retrospective, continuous, multicenter study. The incidence rate of complications from surgery and the factors influencing their frequency were evaluated by uni- and multivariate analysis. The risk of a second operation was studied by actuarial survival analysis. Results After a mean follow-up of 4.5 years, 79 patients (44%) presented with at least one complication, including 32% with a serious complication. The most frequent complications were mechanical. The risk factors were medical co-morbidities, the extent of fusion and the extent of the preoperative sagittal imbalance. A second operation was necessary in 25% of patients at 1 year and 50% of patients at 6 years of follow-up. Discussion Studies in the literature show that functional results are better with surgical treatment than with medical treatment in the management of thoracic spine and thoracolumbar deformities in patients over 50 years old. An objective assessment of this deformity and associated co-morbidity should make it possible to reduce the rate of complications for this type of surgery. Level of evidence Level IV.

Treatment strategies in high-grade L5-S1 spondylolisthesis are controversial. Reduction of slippage, correction of lumbosacral kyphosis and the necessity of a complementary anterior approach are debated in the literature. The present study reports clinical and radiological outcome for reduction and instrumented fusion on a single posterior approach.A retrospective study included all consecutive adolescent and young adult patients operated on by a single surgeon (D.C.) for high-grade (Meyerding 3-4-5) L5-S1 spondylolisthesis. The technique consisted in reduction of lumbosacral kyphosis and posterolateral fusion on a single posterior approach without resection of the sacral dome or complementary anterior approach. Only cases of adult ptosis required impacted tibial interbody graft. Clinical complications, radiologic lumbopelvic results and sagittal balance were analyzed at last follow-up.Fifty patients, with a mean age at surgery of 21±11 years, were followed up for a mean 5.5±4.6 years. Mean lumbosacral angle was reduced by 25° (from 76° to 101°; P0.05), and mean listhesis grade by50% (from 75% to 23%; P0.0001), without correction loss at last follow-up. C7 sagittal offset was corrected (from 8° to 4°; P0.05), with harmonization of lumbar (from 57° to 64°; P0.001) and thoracic curvature (from 37° to 44°; P=0.1). Seventeen patients (34%) showed postoperative radicular deficit, without sequelae at last follow-up. There were no cauda equina lesions. Bone fusion was achieved in 42 patients (84%), in the same surgical step. After revision by complementary interbody graft, there was no residual non-union.Surgery on a single posterior approach gave reliable results in high-grade spondylolisthesis in adolescents and young adults. The technique is not however, free of risk (transient neurologic deficit and non-union), and patients should be forewarned. Complementary interbody graft can be reserved to adult ptosis with incomplete reduction of lumbosacral kyphosis and to revision surgery for non-union.IV, retrospective study.

We compared the kinetic perimetry of the Humphrey Field Anayzer and the Haag Streit Octopus 101 and assessed their use in relation to Goldmann perimetry. The Humphrey kinetic perimetry comes close to Goldmann perimetry and the Octopus shows clear advantages, notably in terms of ergonomics and its more sophisticated software. The Goldmann requires a high level of skill; examination time with the Humphrey and the Octopus is at least double the time required by a skilled Goldmann operator. The examiner can to a certain degree be passive during the static visual field examination, but is entirely active during the kinematic visual field examination. Therefore, contrary to static perimetry, the examination can only be performed by a physician. The future of automated kinematic perimetry depends on simplification of the software.

Introduction: Altered p53 gene product correlates with the stage and grade of bladder tumor, but its value as a predictor of BCG response has been disappointing. In order to revisite the prognostic value of pretreatment p53 nuclear overexpression for the BCG response, we studied a large cohort of consecutive patients with superficial bladder cancer treated with BCG. Methods: From 1988 to 2001, 102 patients with a history of multifocal, recurrent, and/or high-risk papillary transitional cell carcinoma or carcinoma in situ, were treated for the first time with BCG. p53 immunostaining was performed on paraffin-embedded tissues using monoclonal antibody DO7 and an automated immunostainer. Special attention was paid to the conditions of tumor fixation. p53 overexpression was defined as more than 20% tumor cells with p53-stained nuclei. Results: Immunostaining was significantly higher for Ta/T1 G3 ± Cis (p

Lumboscopy provides an approach to the retroperitoneum for the majority of upper urinary tract operations. The technique involves a knowledge of specific anatomical landmarks that differ from those in classical open surgery, because of the inferior approach to the renal pedicle with the kidney initially mobilized in a ventral and cranial position. An anatomical study was conducted on five cadavers, using images from surgical operations, in order to describe the vascular elements of the retroperitoneal spaces as they are approached during lumboscopy, as well as to define specific anatomical landmarks. Identification of psoas major is crucial as it is then possible to locate the renal pedicle opposite and the area of the great vessels medially. During dissection of the renal pedicle the renal vein and its branches are the first elements to be approached. On the left side the distal portion of the renal vein can be confused with a reno-hemi-azygo-lumbar trunk, due to the initial ventral mobilization of the kidney stretching it. Because of the inferior view of the renal pedicle the reno-hemi-azygo-lumbar trunk can obscure part of the renal artery and may be confused with the renal vein. On the right side initial identification of the inferior vena cava on the medial aspect of psoas major facilitates identification of the gonadal, renal and suprarenal veins all located in the same plane.

Summary Purpose To evaluate the efficacy and toxicity of vinorelbine in a phase ll study in patients with progressive metastatic andro-gen-independent prostate cancer. Patients and methods Forty-seven men with progressive metastatic prostate cancer refractory to first-line or second-line hormonal therapy were treated with vinorelbine, a semi-synthetic vinca-alkaloid. Vinorelbine was given, on an outpatient schedule, at 25 mg/m2 weekly for at least eight weeks or until progression or excessive toxicity. Results Forty-seven patients were included in the study, 33 being evaluable for tumour response, 36 for response to PSA, 21 for clinical benefit and 45 for toxicity. Median actual weekly dose was 19 mg/m2 (range 12.0–26.2 mg/m2). Six of thirty-six patients (17%) demonstrated a biologic response with a 50% or more decline in serum PSA on two consecutive measurements taken at least two weeks apart. The median duration of biologic response was 2.7 months. Two of three patients with measurable disease obtained an objective response but remained unconfirmed. No change disease was reported in 23 patients (49%). On entry into the study, 30 patients had symptomatic bone pain and required narcotic or non-narcotic analgesics. Clinical benefit from vinorelbine was achieved in 15 patients out of 21 (32% of the intent to treat analysis population and 71% of the assessable patients). Due to the low number of questionnaires (QLQ-C30) filled in, it was insufficient to allow any statistical analysis. The median survival was 10.2 months. Toxicity was mainly haematologic with 51% of patients experiencing grade 3 or 4 granulocytopenia. Three patients developed deep vein thrombosis. Non-haematologic toxicity, mainly nausea and neurotoxicity, was mild. Conclusions The administration of weekly vinorelbine appears to be a safe treatment for those patients with androgen-independent prostate cancer and poor prognosis features who require chemotherapy. These results provide data for future investigation of vinorelbine in combination regimens.

The p15 gene which encodes a cyclin-dependent kinase inhibitor, is located in the 9p21 chromosomal region that is frequently deleted in human bladder transitional cell carcinomas (TCCs). The aim of the present paper is to study the potential involvement of the p15 gene in the evolution of TCCs. p15 mRNA expression was investigated by semi-quantitative RT-PCR in a series of 75 TCCs, 13 bladder cell lines and 6 normal bladder urothelia by semi-quantitative RT-PCR. p15 was expressed in the normal urothelium but p15 mRNA levels were significantly decreased in 66% of the superficial (Ta-T1) TCCs (P = 0.0015). In contrast, in muscle-invasive (T2-T4) TCCs, p15 expression differed widely between samples. p16 mRNA levels were also studied and there was no correlation between p15 and p16 mRNA levels, thus indicating that the two genes were regulated independently. Lower p15 expression in superficial tumours did not reflect a switch from quiescence to proliferative activity as normal proliferative urothelial controls did not present decreased p15 mRNA levels relative to quiescent normal urothelia. We further investigated the mechanisms underlying p15 down regulation. Homozygous deletions of the p15 gene, also involving the contiguous p16 gene, were observed in 42% of the TCCs with decreased p15 expression. No hypermethylation at multiple methylation-sensitive restriction sites in the 5′-CpG island of p15 was encountered in the remaining tumours. Our data suggest that decreased expression of p15 may be an important step in early neoplastic transformation of the urothelium and that a mechanism other than homozygous deletions or hypermethylation, may be involved in p15 down regulation. © 2001 Cancer Research Campaign http://www.bjcancer.com

Resume Nous presentons un systeme d'aide a la decision preoperatoire en chirurgie correctrice de la scoliose, appele Sadepo. Ce systeme a pour but d'aider les chirurgiens et ses assistants dans la determination de la strategie preoperatoire, en leur presentant des cas de patients similaires operes et ayant un suivi postoperatoire a plus ou moins long terme. Le systeme utilise les mecanismes du raisonnement a partir de cas. La problematique se situe clans la representation d'un cas et la rememoration des cas similaires. Dans ce but, un cas en memoire represente un patient scoliotique opere par le chirurgien qualifie d'expert. Chaque cas est decrit par une trentaine d'attributs en preoperatoire. La rememoration est effectuee, de maniere iterative, par comparaison du nouveau patient avec chaque patient de la base, au moyen d'un indice de similarite. L'evaluation du systeme a ete menee suivant deux axes: une evaluation croisee sur la totalite de la base de patients et une evaluation en milieu clinique, avec le chirurgien-expert, pour juger de la pertinence des cas similaires retrouves. Ces tests effectues en milieu clinique ont montre des resultats probants. Les performances et limites du systeme sont discutees en fin d'article.

Resume Materiel et methode A partir de quatre observations caracteristiques riches en signes cliniques, nous voulons montrer l'interet de l'examen clinique et particulierement neurologique lors du bilan d'une scoliose d'apparence idiopathique. Resultats L'absence partielle et surtout unilaterale des reflexes cutanes abdominaux, associee a une scoliose thoracique a convexite gauche, a des cephalees, a des douleurs cervicales, a une fatigabilite anormale a la marche, doit faire rechercher une cavite syringomyelique. La dissociation thermoalgesique en bande suspendue est tres evocatrice, suspectee parfois par une escarre indolore sous corset platre; un cou court, un torticolis indolore, une diminution de force du long abducteur du pouce ou un tableau neurologique grave evoquant une compression bulbaire constituent autant de signes d'appel heterogenes pour l'examinateur avise. L'IRM est l'examen de choix. Elle localise la cavite syringomyelique, visualise les anomalies associees, en particulier une malformation de Chiari de type 1 (huit cas sur dix). La mise en evidence d'une syrinx va conditionner le traitement de la scoliose et surtout la preceder, decompression cervico-occipitale, bien souvent avant de pratiquer une traction sur le rachis. II est rappele que le developpement d'une syrinx est tres lent debutant parfois en periode postnatale. Conclusion Les relations entre scoliose et syringomyelie sont exposees et il est confirme que l'IRM ne doit pas etre systematique devant une scoliose idiopathique a bilan clinique normal. La sagacite du clinicien quelle que soit sa specialite doit s'inspirer du modele pratique par les cliniciens du siecle dernier.

Various mechanisms of epithelial cell plasticity in morphogenesis have been studied at the genetic and molecular levels. Several control genes have been identified including genes encoding transcription factors and growth factor receptors. These mechanisms may be reactivated during the progression of carcinomas. One of the mechanisms underlying epithelial plasticity is the epithelial–mesenchymal transition. This process has been extensively studied using the NBT-II bladder carcinoma cell line. Cells of this line undergo a reversible transition following exposure to several growth factors including FGF1, EGF, TGFα and SF/HGF, which activate tyrosine kinase surface receptors. Two separate transduction pathways have been identified. The transient activation of c-Src is involved in cytoskeleton remodeling whereas the Ras pathway controls the transcription of genes such as the transcription factor Slug which is involved in the internalization of desmosomes. These two pathways cooperate to induce the morphological transition, scattering and locomotion of fibroblast-like cells. Growth/scatter factor-producing NBT-II cells are more invasive than cells that do not contain this factor, in orthotopic confrontation assay. In vivo, these cells are very tumorigenic and may confer a more malignant phenotype on parental cells via a community effect. The role of several growth factors and their receptors has been investigated in human bladder carcinomas. A subset of these tumors with poor outcomes produce low levels of FGFR2-IIIb. The synthesis of this receptor de novo in bladder cell lines reduces proliferation in vitro and tumor growth in nude mice. FGFR2-IIIb functions as a tumor suppressor, consistent with the differentiation-inducing capacities of FGF receptors in the suprabasal cells of the skin. FGFR2-IIIb signaling may be involved in the maintenance of E-cadherin, the prototype epithelial adhesion molecule, which is only downregulated in a fraction of tumors with low FGFR2-IIIb synthesis. Human bladder tumors may also activate autocrine loops such as that for EGFR and their ligands, as already demonstrated for murine bladder tumors. Therefore, our results suggest that multifunctional growth factors and their receptors are involved in cell proliferation and epithelial cell plasticity, acting either as positive or negative regulators of tumor progression. The effect on the morphological transition is also clearly relevant to the mechanism governing dissemination and the formation of micrometastatic tumor cells. The extrapolation of these discoveries to human carcinomas should provide markers facilitating the more accurate prediction of the biological behavior of a given tumor and identify clinically and pathologically significant parameters. The identification of critical changes in the growth factor pathways involved in tumor progression will not only provide insight into the genetic and molecular basis of this process, but should also identify targets for new therapies.

Introduction L’esperance de vie des patients vivant avec le VIH (PVVIH) s’est considerablement allongee ces 20 dernieres annees grâce aux progres du traitement antiretroviral (ARV), lui permettant d’atteindre celle de la population generale. L’efficacite therapeutique est donc un enjeu majeur. Patients et methodes Nous avons realise une etude retrospective d’une population de PVVIH sous ARV suivie dans un service de medecine interne entre 2007 et 2014. L’efficacite therapeutique a ete evaluee suivant differents schemas therapeutiques. Celle-ci etait consideree satisfaisante lorsque la charge virale etait inferieure a 50/mm3 a 6 mois de traitement. Seuls les patients en 1re ou 2e ligne de traitement ont ete inclus pour exclure le risque de resistance virologique. Les 3 schemas therapeutiques evalues etaient : 1 comprime en 1 prise par jour (groupe A), plusieurs comprimes en une prise par jour (groupe B), plusieurs comprimes en plusieurs prises par jour (groupe C). Resultats Trois cent quarante-quatre patients ont ete inclus (243 en 1re ligne de traitement, 101 en 2e ligne). Le groupe A comptait 90 patients, le groupe B, 207 patients et le groupe C, 47 patients. Les 3 groupes etaient significativement differents en termes d’origine geographique, de mode de transmission et de Nadir moyen de CD4 avant traitement. L’efficacite therapeutique de la population generale etait de 87,5 % et respectivement de 95,6 %, 83,6 % et 89,4 % pour les groupes A, B et C. L’efficacite therapeutique etait significativement differente entre les groupes A et B (p = 0,0041) mais pas entre les groupes A–C et B–C. Ces resultats restaient identiques, que les patients soient en 1re ou 2e ligne de traitement. Conclusion Notre etude montre qu’une meilleure efficacite therapeutique n’est pas uniquement correlee a une baisse du nombre de comprimes ou de prises quotidiennes. Cela laisse supposer qu’elle est aussi liee aux specificites comportementales de la population traitee.

The reactivity of MIB1 antibody on routinely processed paraffin sections was compared with that of Ki-67 antibody on frozen sections of 80 transitional cell carcinomas of the bladder. The percentage of labelled cells was expressed as the labelling index. MIB1 labelling indices were higher than those of Ki-67 but for each case the two values were strongly correlated (r = 0.91). Ki-67 and MIB1 indices were also correlated to tumour grade and stage (Por = 0.001). MIB1 indices determined after both formaldehyde and ethanol based Bouin's fluid fixatives did not show any significant difference. MIB1 antibody staining after microwave oven heating of tissue sections is a simple technique for assessing the proliferative fraction of bladder tumours on fixed material. The use of MIB1 antibody permits retrospective studies and should determine whether the proliferation index in bladder carcinoma has the same prognostic value as demonstrated in other types of neoplasms.

The effectiveness of a macroporous biphasic calcium phosphate ceramic was studied after laterovertebral arthrodesis in sheep. A ceramic with a TCP/HAP ratio of 35/65 was compared with autogenous bone graft 1, 3, 6, 9 and 12 months after implantation. Surface, lengths, and relative pore parameters have been quantified by using light microscopy and image analysis. Quantitative analysis of the results indicated that the biphasic ceramic allows an arthrodesis after 12 months, although control graft is effective after six months. The implanted material is still present after 12 months. Degradation of the ceramic is initially fast, then slows down. The intra-implant new bone formation reaches 15% after three months and 19% after 12 months. In contrast, bone ingrowth increases from 9% after three months to 23% after 12 months in intertransverse zone. Bone formation was seen with a higher frequency in pores of 240–480 µm in average diameters. New bone fills only one part of the area of a pore. A spinal fusion can be obtained with this biphasic ceramic, but the use of this material cannot be currently recommended without further investigations.

We compared the kinetic perimetry of the Humphrey Field Anayzer and the Haag Streit Octopus 101 and assessed their use in relation to Goldmann perimetry. The Humphrey kinetic perimetry comes close to Goldmann perimetry and the Octopus shows clear advantages, notably in terms of ergonomics and its more sophisticated software. The Goldmann requires a high level of skill; examination time with the Humphrey and the Octopus is at least double the time required by a skilled Goldmann operator. The examiner can to a certain degree be passive during the static visual field examination, but is entirely active during the kinematic visual field examination. Therefore, contrary to static perimetry, the examination can only be performed by a physician. The future of automated kinematic perimetry depends on simplification of the software.

In the last decades, scientists developed analytic models of spinal surgery to assess surgical choices and instrumentation parameters. They noted the difficulty to represent the boundary conditions on their deterministic models and recognize the lack of knowledge in surgical procedures. This paper presents a formalization technique applied to spinal surgery to improve the formulation of biomechanical models. This technique consisted into two steps: knowledge extraction and knowledge representation. The protocol was established with an expert surgeon using Colorado2 instrumentation. Surgeon's knowledge acquisition has permitted to define eleven detailed independent data cards for the different steps of surgery like hook or screw insertion, rod installation, etc... The behaviour of the concerned elements on its neighbouring entity were specified using three matrices. The link between surgery and modelling becomes easier and permits to better define the boundary conditions on each entity during the simulation.

Few biomechanical models of the scoliotic spine were developed to simulate the Cotrel-Dubousset instrumentation, although none was dedicated to the Colorado system. The objective of this study is to adapt and assess an existing biomechanical model to simulate the effect of the Colorado instrumentation of the scoliotic spine as a function of pre-operative geometry and surgical planning. Fifteen scoliotic patients operated with a Colorado system were analysed using a knowledge extraction technique to simplify surgical procedure and to establish the biomechanical model (boundary conditions, simulation procedures,...). Preliminary results on one patient show that the Colorado surgical technique can be adequately modelled using the preoperative geometric data and limited simulation strategy parameters.

OBJECTIVE To evaluate the complication rate and clinical follow-up of patients treated for T1 renal cancer by open or laparoscopic nephrectomy at the same institution, as this approach appears to be attractive for treating small renal cancers. PATIENTS AND METHODS Between 1995 and 2002, 39 patients underwent retroperitoneal laparoscopic and 26 transperitoneal open radical nephrectomy for T1 renal cancer (TNM 1997). Variables before during and after surgery, e.g. cancer recurrence, were compared between the groups. RESULTS There were no differences between the laparoscopic and open groups in age, sex ratio, weight, height, fitness score, operative duration (134 vs 133 min), minor or major complications, tumour diameter, Fuhrman grade or length of follow-up. Patients who underwent laparoscopic surgery had less blood loss (133 vs 357 mL, P

The objective of this work was to evaluate the oncological outcomes and complications of prostate cancer patients with prostate specific antigen (PSA)10 ng/ml after radical prostatectomy by retropubic, perineal and laparoscopic approach. From 1988 to 2001, 306 patients with PSA10 ng/ml underwent radical prostatectomy by the retropubic, perineal or laparoscopic approach. Mean operative time, complication rates, length of hospital stay, catheterization time and pathological results were reviewed. Kaplan-Meier analysis was used to evaluate the likelihood of biochemical PSA recurrence. There were no statistical differences between the three groups in terms of preoperative characteristics except for PSA levels (5.5, 6.5 and 6.6 ng/ml for the retropubic, perineal, and laparoscopic approach, respectively, P0.05) and for the T1c stage prevalence (50%, 43.1% and 68.4%, P0.05). Operating time was significatively longer in the laparoscopic approach (266 min), whereas transfusion rate (22.1%), bladder catetherization (12.1 days), and length of hospital stay (12.1 days) were higher in the retropubic group (P0.05). The percentage of medical and surgical complications were 6.9%, 3.1% and 3.4% (P0.05) and 18.6%, 16.9% and 11.6% (P0.05) for the retropubic, perineal, and laparoscopic approach, respectively. Pathological staging revealed pT2 in 76.7%, 78.4% and 81.3% for retropubic, perineal and laparoscopic approach, respectively (P0.05). Positive surgical positive margins were noted in 20.9%, 18.4% and 20.6% (P0.05). The actuarial 3-year recurrence-free survival rate was 89.3%, 89.2% and 86.2% (P0.05) for retropubic, perineal and laparoscopic approach, respectively. It can be concluded that in patients with preoperative PSA10 ng/ml, clinical outcome and complication rates were similar, regardless of the choice of surgical approach.

The use of Bacillus Calmette-Guérin (BCG) vaccine as immunotherapy for superficial bladder cancer constitutes a major progress, although it remains limited by the development of adverse effects and problems related to safety. No individual tool is currently available in clinical practice to predict the efficacy or adverse effects of BCG therapy. These problems are accentuated in the case of maintenance therapy according to the protocol of D.L. Lamm.To define whether the urinary leukocyte count observed after intravesical BCG instillation could be associated with adverse effects and efficacy of treatment.A cohort of 72 consecutive patients (518 instillations) was studied prospectively. We defined four classes of adverse effects associated with BCG, according to their type, severity and duration. In combination with this classification, we performed systematic optical urinary leukocyte count on the third day after each instillation (KOVA-Slide 10).A high urinary leukocyte count (cut-off value: 165,000/ml) was correlated with absence of recurrence (p = 0.009). The adverse effect classification also demonstrated that urinary leukocyte count was related to the severity and duration of adverse effects (p0.0001). Median values observed for class I, II and III adverse effects were 40,000 leukocytes/ml, 150,000 leukocytes/ml and 350,000 leukocytes/ml, respectively. No class IV adverse effects were observed. The risk of developing class III adverse effects was increased when the urinary leukocyte count was greater than 86,000 leukocytes per ml.These results suggest a probable relationship between efficacy and safety of BCG, during maintenance therapy. Randomized prospective studies are necessary to evaluate urinary leukocyte count as a tool for adaptation and optimization of BCG therapy.

The use of fluoroquinolones in urology has grown considerably over recent years. Unfortunately, although these molecules are not associated with severe life-threatening complications, they have nevertheless been associated with tendon lesions responsible for functional disability. The frequency of these complications is probably underestimated. There is a variable lag-time (3 to 5 days) between introduction of the antibacterial and onset of pain. The symptom most frequently reported is pain over the tendon affected and the tendons most frequently affected are those submitted to high constraints. Bilateral lesions are present in 66% of cases. Although Pefloxacin is associated with the highest frequency of tendon complications (2.7% versus 0.2-0.3% for other fluoroquinolones), the duration of treatment appears to be important in every case, with a peak frequency after a fortnight of treatment. Although these complications were considered for a long time to be associated with patients presenting certain risk factors (age, steroid therapy, renal failure), they can also occur suddenly, in young adult sportsmen or non-sportsmen, with no known tendon disease. Several hypotheses have been proposed to explain the development of these cases of tendinopathy: immuno-allergic mechanisms, direct toxicity of the molecule on collagen fibres, cell-mediated oxidative aggression, or tendon necrosis due to vascular mechanisms. The outcome remains favourable in 75% of cases of tendinitis and in 49% of cases for tendon rupture. Contraindications must therefore be identified and the duration of treatment must be adapted, as the functional handicap can be long and particularly severe.

Living-donor nephrectomy is performed via a standard flank approach during open surgery in contrast to laparoscopy where kidneys are procured transperitoneally. Being more familiar with retroperitoneal laparoscopy for the surgery of the upper urinary tract, we investigated the feasibility of live donor nephrectomy by this approach.We performed laparoscopic retroperitoneal left-sided nephrectomy in 3 living donors. The patients were placed in lumbotomy position. The retroperitoneal space was developed with blunt finger dissection, through a 2-cm mini-lumbotomy under the 12th rib in the posterior axillary line. 5 trocars were inserted. After primary access to the renal artery and vein, these were dissected to their junctions with the aorta and inferior vena cava, respectively, before freeing the kidney of its perinephric attachments. The kidney was delivered manually, through the slightly enlarged initial subcostal incision.The average duration of surgery was 83 min; warm ischemia time less than 5 min. Average blood loss was 120 cm(3). Donors did not present any postoperative morbidity and were discharged after an average of 2.3 days. Mean analgesic requirement was 5 mg morphine sulphate equivalent (0-15). Average convalescence was 13.3 days (10-18). All 3 kidneys harvested laparoscopically had immediate function with urine production after graft revascularization; serum creatinine levels returned to normal within 1 week. The first patient presented ureteral stenosis 2 months after surgery. He underwent ureteropyeloplasty using his native ureter.Laparoscopic living-related-donor nephrectomy become a new standard for organ harvesting. Our data suggest that retroperitoneal laparoscopic donor nephrectomy may represent a reasonable option in centers in which more extensive experience has been accumulated with retroperitoneal than with transperitoneal laparoscopy for the surgery of the upper urinary tract.

Maintenance treatment with complementary BCG instillations in the prevention of superficial bladder tumour could improve the results of this immunotherapy. This maintenance treatment is limited by accentuation of the adverse effects related to BCG.To evaluate the impact of maintenance treatment on tumour recurrence and progression, and to evaluate the influence of adverse effects on maintenance treatment and the recurrence rate.72 patients were treated with six weekly instillations of 81 mg of BCG (Immucyst) followed by three complementary instillations 3, 6, 12, 18, 24, 30 and 36 months later. Adverse effects (AE) were classified into four classes, according to their type, severity and duration, and were recorded prospectively for 518 instillations. An adverse effect score was determined for each patient.84.9% of patients did not present any recurrence, 12.5% developed recurrence and 2.6% progressed. The instillation regimen was completed by 19% of patients, the dose had to be decreased for 57% of patients and treatment had to be discontinued for 39% of patients. An initial adverse effect score (AESi) greater than 1.5 was associated with an increased risk of discontinuation of treatment or reduction of the dosage during maintenance treatment (p = 0.01).Maintenance treatment was associated with a very low recurrence and progression rate. We have established and validated an adverse effect severity scale and the consequences of these adverse effects on maintenance treatment. This scale could be used to prospectively define the most appropriate maintenance instillation regimen, by preventively decreasing the doses or deferring instillation.