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Background Silicone adhesive multilayer foam dressings are used as adjuvant therapy to prevent hospital-acquired pressure ulcers (PUs). Objectives To determine whether silicone foam dressings in addition to standard prevention reduce the incidence of PUs of category 2 or worse compared with standard prevention alone. Methods This was a multicentre, randomized controlled medical device trial conducted in eight Belgian hospitals. At-risk adult patients were centrally randomized (n = 1633) to study groups based on a 1 : 1 : 1 allocation: experimental groups 1 (n = 542) and 2 (n = 545) - pooled as the treatment group - and the control group (n = 546). The experimental groups received PU prevention according to hospital protocol, and a silicone foam dressing on the relevant body sites. The control group received standard of care. The primary endpoint was the incidence of a new PU of category 2 or worse at the studied body sites. Results In the intention-to-treat population (n = 1605), PUs of category 2 or worse occurred in 4·0% of patients in the treatment group and 6·3% in the control group [relative risk (RR) 0·64, 95% confidence interval (CI) 0·41-0·99, P = 0·04]. Sacral PUs were observed in 2·8% and 4·8% of the patients in the treatment group and the control group, respectively (RR 0·59, 95% CI 0·35-0·98, P = 0·04). Heel PUs occurred in 1·4% and 1·9% of patients in the treatment and control groups, respectively (RR 0·76, 95% CI 0·34-1·68, P = 0·49). Conclusions Silicone foam dressings reduce the incidence of PUs of category 2 or worse in hospitalized at-risk patients when used in addition to standard of care. The results show a decrease for the sacrum, but no statistical difference for the heel and trochanter areas.

Resume Introduction Malgre les recommandations regulieres emises par l’European Society for Medical Oncology (ESMO), la prise en charge des lesions des tissus mous est encore trop souvent insuffisante, pouvant aggraver le pronostic fonctionnel mais aussi vital du patient. Methode Une etude a ete menee au centre de reference de Lorraine. Tous Les patients inscrits dans la base de donnees NetSarc, au decours d’un passage en RCP, entre le 1er janvier 2010 et le 1er septembre 2016 ont ete inclus. Les criteres de conformite de prise en charge ont ete etablis en utilisant le dernier referentiel ESMO 2014, permettant de distinguer deux groupes, « conforme » et « non conforme » aux recommandations. Une premiere analyse comparative a ete faite entre les deux groupes toutes lesions confondues. Puis une seconde uniquement sur les sarcomes. Resultats Au total, 445 patients presentant une lesion des tissus mous ont ete inclus, 344 cas ont ete traites selon les recommandations de l’ESMO, soit un taux de conformite de 77,3 %% (IC95 % : 73,4 %, 81,2 %). La conformite etait meilleure pour le centre de reference que pour les structures peripheriques (p Conclusion Le respect des recommandations de l’ESMO, permet d’ameliorer la qualite de l’exerese chirurgicale des sarcomes et evite les gestes chirurgicaux inappropries.

Introduction La prise en charge des patients presentant des maladies infectieuses et tropicales (MIT) est complexe, notamment du fait du risque epidemique et biologique (REB). Un bâtiment dedie a la prise en charge des MIT a toujours semble pertinent, notamment pour les Etablissements de sante de reference (ESR), mais le cahier des charges de telles structures n’est pas connu dans sa version definitive. Materiels et methodes En 2013 (epidemie de maladie a virus Ebola), la decision de construire un bâtiment dedie a la prise en charge des MIT, prenant en compte le risque REB a ete decide. Le budget etait de 15 millions d’euros. Sur la periode 2013–2019, un travail de partage et de concertation a ete entrepris entre infectiologues, hygienistes, reanimateurs, pediatres, referents NRBC, ingenieurs, architectes, cadres de sante et direction hospitaliere. L’objet etait d’imaginer une structure composee de 45 chambres a un lit, dont certaines pouvant accueillir des patients infectes avec pathogenes hautement contagieux, avec des flux dedies et une modularite en fonction du risque epidemique. Resultats Un bâtiment dedie unique a pu etre construit sur la periode 2019–2021. Ce bâtiment abrite au RDC le CeGGID. Concernant l’hospitalisation conventionnelle, le bâtiment abrite de 45 chambres a un lit, dont 16 chambres pressurisees sassees. Une unite d’hospitalisation conventionnelle de 22 lits se situe au 1er etage. Deux de ces lits sont localises dans un secteur de haute isolement (HI), avec une salle de soin dediee, des sas d’entree, une marche en avant, et des sas de sortie avec dans chacun d’eux un autoclave pour que les dechets puissent ensuite suivre la filiere classique des dechets. Les deux chambres HI ont ete concues pour etre transformables en chambre de reanimation en cas de defaillance d’organe, pour eviter le transfert d’un patient contagieux en reanimation. Ce secteur HI est extensible a une capacite de 12 lits au total, dont 4 sont equipables en chambre de reanimation), avec mise en depression du couloir de ce secteur, avec un sas d’entree et un sas de sortie dedies, le tout restant independant du reste du bâtiment en termes de flux. Une autre unite est situee au 3e etage du bâtiment, et celle-ci est composee de 23 chambres seules sassees, dont 4 sont en pression negative. Conclusion Apres 6 annees de conception et deux ans de construction, ce nouveau bâtiment dedie aux maladies infectieuses d’une grande modularite permet la prise en charge de patients REB et non REB, avec un maximum de confort pour les patients, pour les soignants, avec une reduction du risque de transmission nosocomial des pathogenes les plus contagieux.

Background Mastectomy with immediate breast reconstruction (IBR) is a surgical strategy in breast cancer when breast-conserving surgery is not an option. There is a lack of evidence showing an advantage of mastectomy plus IBR over mastectomy alone on health-related quality of life (QoL). Methods A large prospective multicentre survey, STIC-RMI (support of innovative and expensive techniques – immediate breast reconstruction), was undertaken to study the changes in QoL in patients treated by mastectomy with or without IBR. Patients were recruited between 2007 and 2009. European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 instruments were used to assess QoL before operation, and at 6 and 12 months after surgery. A propensity score was used to compare QoL between mastectomy alone and mastectomy plus IBR, with limited bias. Results A total of 595 patients were included from 22 French academic hospitals, of whom 407 (68·4 per cent) underwent IBR. One-year data were available for 71·1 per cent of patients. Factors associated with IBR were age, histological tumour type, palpable nodes and an attempt at breast-conserving surgery. At inclusion, QoL was significantly better in the IBR group (P < 0·001) and there was no significant change in either group during 1 year compared with baseline. Results for the QLQ-BR23 functional dimension varied according to propensity score quartiles; IBR had no influence in the lowest quartile. In the upper quartiles, QoL increased slightly over the year among patients who had IBR, whereas it decreased among those who had mastectomy alone (P = 0·037). Satisfaction with the cosmetic outcome strongly influenced QoL, especially in upper quartiles (P < 0·001). However, an unsatisfactory outcome after IBR was still considered a better condition than simple mastectomy. Conclusion The QoL benefit provided by IBR depends on patients' life status at inclusion; young active women with an in situ tumour are more likely to preserve their QoL after IBR.

Background Half of the patient treated with neoadjuvant chemotherapy (NAC) for a large operable breast cancer has no axillary lymph node involvement at the time of surgery. Sentinel lymph node detection (SLND), after NAC, is aimed to select patient who should be safely spared of an axillary lymphadenectomy (ALND).GANEA 2 is a French prospective multi institutional trial, aimed to assess SLND after NAC. Objective To assess the risk of relapse for patients without previous axillary node involvement treated with NAC followed with a SLND without a systematic lymphadenectomy. Patients and Method Inclusion: FIGO stage T1-T3 infiltrating breast carcinoma, indication of NAC. Exclusion: inflammatory cancer, local relapse, contra-indication to NAC, NAC interrupted due to progressive disease. Design: indication to plan a NAC, axillary sonography with fine needle cytology before NAC to select patients without lymph node involvement, SLND after NAC. ALND was mandatory in case of SLN involvement (macro or micro-metastasis) or SLND failure. Follow-up was scheduled with a medical visit / 6 months with axillary assessment and a mammography each year. Follow-up results are updated every 6 months. Pathological analysis were carried out according to standard methods and classified according to the last American Joint Committee staging system. Studied parameters were SLND detection rate, pathological results on breast specimen and nodes, rate of relapse (axilla, breast, metastasis), and survival. Results From July 2010 to February 2014, 587 patients were enrolled, from 17 institutions, and experienced breast tumor surgery and a SLND after NAC. Each patient experienced breast surgery. A breast tumour pathological complete response was found in 21.3% (125/587). SLND rate was 97% (570/587), with a median number of 2 sentinel nodes (1-9). Patients with a sentinel detection failure (n=17) experienced a systematic lymphadenectomy, without any involvement (n=13), a micro-metastasis (n=2) and a macro-metastasis (n=2). A total of 140 patients had at least one sentinel node involved: macro-metastasis (n=86), micro-metastasis (n=54). A lymphadenectomy was performed in 128 cases: metastasis free (n=100), macro-metastasis (n=17), micro-metastasis (n=11). A total of 430 patients had a SLN metastasis free (75% ;430/570). A not mandatory lymphadenectomy was performed (n=14): metastasis free (n=11), macro-metastasis (n=2) and micro-metastasis (n=1). 17 patients were lost to follow-up. A total of 399 patients without sentinel node involvement were followed 2.3 years (from 0.5 to 5.6 yrs). At 3 years overall survival was 97.8% [94.9-99.1], disease free survival was 94.8% [91.0-97.1%]. Six patients died. Fifteen patients experienced a relapse: 8 metastasis, 4 homolateral breast, 2 controlateral breast, 1 homolateral axillary relapse. Conclusion This is the most important series of patients followed 2.3 years after SLND without axillary lymphadenectomy after NAC for an advanced breast cancer, showing acceptable results. The current series validate the safety of this conservative strategies avoiding systematic lymphadenectomy to patients without initially involved axillary node treated with NAC. Citation Format: Classe J-M, Loaec C, Alran S, Paillocher N, Tunon-Lara C, Gimbergues P, Faure-Virelizier C, Chauvet M-P, Lasry S, Dupre P-F, Verhaeghe J-L, De Blaye P, Gutowski M, Barranger E, Lecuru F, Lefevre Lacoeuille C, Loussert L, Lambaudie E, Ferron G, Campion L. Sentinel node detection after neoadjuvant chemotherapy in patient without previous axillary node involvement (GANEA 2 trial): Follow-up of a prospective multi-institutional cohort [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S2-07.

Despite regular recommendations issued by the European Society for Medical Oncology (ESMO), patients faced still too often inadequate care with a direct influence on prognosis.A retrospective study was carried out at the Competence center in Lorraine Area. Patients registered in the NetSarc database between 1st, 2010 and September 1st, 2016 were included. Compliance criteria were established using the latest ESMO 2014 referential. Two groups "conforming" and "non conforming" were analyzed. A first analyze about all of the soft tissue lesion and a second only about sarcomas.In total, 445 patients were eligible, 344 cases were treated according to the ESMO guidelines, giving a 77.3% conformity rate (95% CI: 73.4%, 81.2%). Compliance was better for the competence center than district hospitals (P0.001), with compliance rates of 88.7%, and 51.6%, respectively. Among the 247 sarcomas, we found a R0 resection rate better according to the ESMO guideline, 55% against 18% (P0.001). R1 rates were 34% vs. 56% and R2 11 vs. 26% disease free survival was not related significantly to the observance of recommendations in the univariate analysis. After adjustment on potential DFS prognostic factors, in the multivariate analysis, the results were similar.Compliance with the ESMO guidelines, through appropriate management, improves the quality of surgical excision for sarcomas and avoids non-corresponding surgical gestures.

Soft tissue sarcomas are rare malignant tumors with a great variety of histological types and different response to multimodality treatment. Pazopanib has been recently introduced for the treatment of non-adipocytic metastatic soft tissue sarcomas which are resistant to conventional chemotherapy. Spontaneous pneumothorax is a rare but well recognized complication of this molecule and its treatment is quite challenging. The case reported herein describes the surgical management of a simultaneous bilateral spontaneous pneumothorax in a patient with pulmonary metastases treated with pazopanib. It underlines the fact that the main objective should be the maintenance of the treatment in patients who benefit from it. Close oncologic and surgical collaboration is crucial in order to deal with adverse effects due to the anti-angiogenic action of pazopanib.

Reconstruction of the mandible with microvascularized fibula transplants is actually a well-established procedure, yet the major component is the limited diameter of the diaphysis that can induce oral rehabilitation's failure, especially in dentate patients. In this paper, we report our surgical procedure allowing preservation of the mandibular height. The primary objective was to assess aesthetic and functional improvements of preservation of an osseous mandibular rim with a fibula free flap reconstruction.Five patients (all males, mean age of 60 years) were treated with this method. Aetiologies were tumour in 3 cases, and osteoradionecrosis in the two others cases. We described all step of our surgical procedure and the functional, aesthetic and carcinologic results were evaluated. The follow up varies from 6 to 30 months.One patient died at 12 days from unrelated affection. For the other patients, both the aesthetics and functional outcomes were better than in case of mandibular interruption surgery. In fact, the mandibular contour of the mandibule was preserved and the height of mandible was restored. One patient is in progress of dental rehabilitation with osseous implants. Carcinologically, no local recurrence was observed.This technique is reliable and enables to optimize oral rehabilitation with endosteal implants. Nevertheless, we consider that the 3D scanner is essential before the intervention to evaluate the osseous reach. Moreover, if necessarily the procedure can be modified intraoperatively.

Soft tissue sarcomas are rare malignant tumors with a great variety of histological types and different response to multimodality treatment. Pazopanib has been recently introduced for the treatment of non-adipocytic metastatic soft tissue sarcomas which are resistant to conventional chemotherapy. Spontaneous pneumothorax is a rare but well recognized complication of this molecule and its treatment is quite challenging. The case reported herein describes the surgical management of a simultaneous bilateral spontaneous pneumothorax in a patient with pulmonary metastases treated with pazopanib. It underlines the fact that the main objective should be the maintenance of the treatment in patients who benefit from it. Close oncologic and surgical collaboration is crucial in order to deal with adverse effects due to the anti-angiogenic action of pazopanib.

La chirurgie robotique represente une des innovations technologiques majeure de ces dix dernieres annees. Si les avantages du robot s’imposent a tout utilisateur, il doit neanmoins faire la preuve de son benefice pour le patient. Nous developpons ses indications actuelles et futures en chirurgie oncologique, ses progres techniques en devenir. Sa diffusion passera par ses ameliorations technologiques et aussi par une diminution des couts. L’apprentissage est plus rapide que pour la coelioscopie standard. Le gain le plus evident aujourd’hui est au profit du chirurgien avec une ergonomie nettement amelioree et probablement une diminution des troubles musculosquelettiques (TMS) generes par la coelioscopie standard.

Granulosa cell tumors of the ovary are rare tumor of ovary, included in the sex cord-stromal tumor category, hormone secreting. Seventeen patients with adult-type granulosa cell tumor were identified between 1995 and 2012. All have received surgical treatment first at stage I. Thirty-three percent of the patients relapsed with peritoneal nodules in 68% of the cases, treated surgically and sometimes with complementary therapies, such as chemotherapy, radiotherapy, hormonal treatment. Overall survival and recurrence-free survival were 100% and 58.3%, respectively at 10 years with median time to recurrence of 6 years (4-27). These tumors have therefore a good prognosis and require long-time follow-up. Finally, the prognostic factors of recurrence identified in the literature are FIGO stage, the presence of residual tumor and tumor size.

Aims To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients. Results Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2. Conclusions The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis.

Resume Objectifs de l'etude Faire une mise au point sur les donnees recentes de la litterature concernant l'anatomie fonctionnelle du drainage lymphatique mammaire, observee au cours des interventions de prelevement du lymphonœud sentinelle ; comparer l'anatomie descriptive au regard de ces nouveaux resultats. Patients et methodes La population de notre etude anatomique descriptive est composee de cinq patientes. Toutes les patientes ont subi une mastectomie radicale au cours de laquelle, une injection de 2 ml de bleu patente, realisee au niveau periareolaire a permis d'observer les vaisseaux lymphatiques glandulaires. Les recherches bibliographiques ont ete menees sur le site Internet de la National Library of Medicine, ainsi que sur le site Internet de la bibliotheque d'anatomie de la faculte de medecine des Saints-Peres (Paris). Resultats L'anatomie lymphatique du sein a ete decrite depuis plus d'un siecle a partir de travaux menes sur des sujets anatomiques. Des travaux recents, realises au cours d'une intervention de prelevement de lymphonœud sentinelle, ont enrichi ces donnees descriptives de nouvelles donnees anatomiques fonctionnelles sur le drainage lymphatique de la glande mammaire. Ainsi, les voies de drainage lymphatique superficielles deja decrites par Sappey, drainaient le parenchyme glandulaire superficiel jusque dans les lymphonœuds axillaires. Un reseau profond decrit plus recemment par Hidden drainait le parenchyme glandulaire profond jusque dans la chaine mammaire interne et dans les lymphonœuds axillaires. Les resultats de notre etude sur sujets vivants ont corrobore les donnees descriptives et fonctionnelles connues. Conclusion Grâce a la technique du lymphonœud sentinelle, l'anatomie descriptive decrite depuis 1885, s'enrichit de nouvelles donnees fonctionnelles qui permettent d'une part de mieux comprendre l'anatomie descriptive et d'autre part, d'apprehender le risque metastatique lymphonodal dans le cancer du sein. Ces donnees recentes sont d'un interet reel, tant anatomique que therapeutique, et constituent un axe de recherche interessant.

Background: Radiofrequency (RF) is a method of in situ destruction of liver tumor. Biliary complications are bile ducts stenosis or biliary abcess. The aim of this work was to study consequences of liver RF on bile ducts. Methods: A porcine model of biliary lesions was created using radiofrequency ablation liver. Twenty-two pigs were used for the study. The RF RITA 1500 generator (RITA Medical Systems, Mountain View, Calif., USA) was used for all experiments. The needle was positioned under sonographic control in liver parenchyma beside bile ducts. Two lesions were performed in left liver. Four groups of 5 pigs were treated. The pigs were sacrificed 1 or 3 weeks after the procedure. Pringle maneuver was utilized in half of the RF procedures. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions of liver parenchyma near and at a distance from the RF lesions were taken for pathological studies. Results: Radiological lesions were biliary stenosis, with or without upstream bile duct dilatation, or complete interruption of the bile duct, or extravasation of the radiological contrast agent. Histological lesions of bile ducts were observed near RF lesions and at distance of the RF lesions when a Pringle maneuver was used or when the liver was removed after 3 weeks. Conclusions: RF ablation in contact of the intrahepatic bile duct induced biliary lesions. Therefore, it is required to stay away from the bile duct or to protect it when performing RF ablation.

Resume Objectifs. – Le cancer du sein survenant chez la femme tres jeune est rare et son diagnostic et sa prise en charge sont parfois difficiles. L’objectif de l’etude etait d’en analyser les caracteristiques epidemiologiques et clinicopathologiques et surtout d’evaluer les resultats des therapeutiques instaurees. Patientes et methodes. – Les dossiers de trente patientes âgees de 30 ans ou moins, chez qui un diagnostic de cancer invasif du sein a ete porte entre 1986 et 2001, ont fait l’objet d’une etude retrospective dans le service de radiotherapie du centre Alexis-Vautrin. Resultats. – Six patientes (20 %) avaient un antecedent familial de cancer mammaire. Dans 90 % des cas, le signe revelateur etait un nodule cliniquement palpable, de taille moyenne de 3,5 cm. Il s’agissait de 11 cancers de stade I, 11 de stade II, de 6 de stade III et de deux de stade IV. Cinq cancers ont ete decouverts au decours d’une grossesse (taille clinique moyenne = 5,8 cm). Une chimiotherapie neoadjuvante a ete prescrite chez 11 patientes. Vingt trois fois sur 28 (82 %), le sein a pu etre conserve. Il s’agissait d’un carcinome canalaire infiltrant de grade III dans 13/27 cas et une fois sur deux, il s’accompagnait d’une atteinte ganglionnaire axillaire. Les recepteurs œstrogeniques etaient absents dans 11/26 cas. Apres un suivi post-therapeutique median de 5 ans, on a constate six recidives locales (20 %), quatre cancers du sein controlateral et trois cancers secondaires. Dix patientes (38 %) sont decedees dans un tableau d’evolution metastatique ulterieure. Le taux de survie globale a 5 ans etait de 78 %. Conclusion. – Ces resultats rejoignent les donnees de la litterature qui soulignent le pronostic defavorable du cancer du sein chez les femmes tres jeune et incitent a adapter en fonction de l’ensemble des facteurs pronostiques les indications des therapeutiques locales et des traitements adjuvants systemiques et hormonaux.

Granulosa cell tumors of the ovary are rare tumor of ovary, included in the sex cord-stromal tumor category, hormone secreting. Seventeen patients with adult-type granulosa cell tumor were identified between 1995 and 2012. All have received surgical treatment first at stage I. Thirty-three percent of the patients relapsed with peritoneal nodules in 68% of the cases, treated surgically and sometimes with complementary therapies, such as chemotherapy, radiotherapy, hormonal treatment. Overall survival and recurrence-free survival were 100% and 58.3%, respectively at 10 years with median time to recurrence of 6 years (4-27). These tumors have therefore a good prognosis and require long-time follow-up. Finally, the prognostic factors of recurrence identified in the literature are FIGO stage, the presence of residual tumor and tumor size.

Resume L'etude porte sur 346 carcinomes de la cavite buccale (244 langues mobiles et 102 planchers de bouche) traites par curietherapie seule pour la tumeur primaire. On denombrait 199 T1, 131 T2, 14 T3 et 2 TX NX. Parmi les T1, 36 patients ont eu un evidement ganglionnaire ainsi que 73 T2. La curietherapie a ete realisee selon le systeme de Paris. Les curages du cote lesionnel ont ete 59 fois un grand curage du cou, dans 14 cas un curage conservateur et dans 45 cas un curage sous-maxillaire et sous-mental. Un evidement controlateral associe a ete fait dans 20 cas. Une irradiation complementaire des aires ganglionnaires a ete realisee dans 28 cas. Resultats: pour les T1, le controle local (CL) est a 96%, le controle locoregional (CLR) a 83%, la survie specifique (SS) a 88%, la survie globale (SG) a 73%. Pour les T2, CL 85%, CLR 70%, SS 75%, SG 52%. Pour les T3, CL 64%, CLR 44%, SS 25%, SG 18%. La difference est tres significative entre les T1, T2, T3 ( p cf tableau IV). Les recidives ganglionnaires sont plus frequentes chez les patients sans curage que chez ceux avec curage pour les T1, T2, N0, mais cela n'est significatif que pour les CLR, la SS et la SG entre les patients a ganglions negatifs au curage et ceux a ganglions positifs ( p

Surgical resection remains the standard treatment for patients with resectable retroperitoneal sarcomas. The aim of this study was to retrospectively analyse the outcomes of patients with primary retroperitoneal sarcoma.We analysed data of 50 patients with primary retroperitoneal sarcoma who underwent curative-intent resection from 1975 to 2008. External beam radiotherapy and chemotherapy were delivered postoperatively. Demographics, surgical, pathological variables and chemo/radiation therapy were analysed as prognosis factors.There were 22 males and 28 females (mean age 54 ± 13 years). Surgery required visceral resections in 30 patients. There were 16 leiomyosarcomas, 25 liposarcomas and eight other sub-types. Twenty-one patients had clear surgical margins. Twenty-eight patients received postoperative external beam radiotherapy (median 45 Gy) and 15 received chemotherapy. At the end of the follow-up (median 55 months), local recurrence occurred in 39% (n=14) among R0/R1 resection group (n=36). Postoperative external beam radiotherapy tends to increase the time of local recurrence from surgery (27 vs. 13 months, P=0.05). The overall survival rates were 81%, 55% and 46% at 1, 3 and 5 years, respectively. Although R0 resection (P=0.01), well tumour differentiation (P=0.004) and postoperative external beam radiotherapy (P=0.02) significantly influenced overall survival in univariate analysis, only R0 resection was an independent prognostic factor in a multivariate analysis.We confirm the pre-eminence of radical surgery with negative margins as major prognostic factor and the benefit of postoperative radiotherapy.

We have studied the post-treatment follow-up of patients with history of limb soft tissue sarcoma including MR imaging to determine its added value compared to simple clinical follow-up and the impact of MR imaging findings on patient management. We have also studied the value of chest CT to detect metastases.Retrospective study of 85 patients treated for limb soft tissue sarcoma with post-treatment MR imaging of the affected region. We have studied the percentage of local recurrences and the modality of detection of these recurrences. We have evaluated the impact on management of patients with abnormalities detected on MRI. For distant metastases, we have recorded their percentage and date of occurrence.There were five cases of local recurrence, for a percentage of 6%, with 50% detected clinically. The percentage of metastases was 26%. Six biopsies were performed and complementary examinations were performed in 18 cases based on abnormalities detected on MR.These results are in keeping with recommendations from the Fédération nationale des centres de lutte contre le cancer. Imaging is necessary to detect lung metastases.

The identification and description of the basic psychological process linked with the focus of family members' functioning during the acute phase of traumatic coma.Earlier research learned that hope is a core category in coping with traumatic coma. Hope seems to be the drive to keep family members going and to enable them to fulfil their main task namely protecting. In two articles on the focus of family members functioning, this task is defined and the process linked with it is described.A qualitative approach according to the grounded theory method with constant comparison.Twenty four in-depth interviews with 22 family members of 16 patients with traumatic coma.Family members describe the period after the confrontation with traumatic coma as a battle. During this battle, they feel the urge to protect their relative in coma, other family members and themselves. They go through three phases: protecting life, protecting from suffering, protecting what remains to rebuild live. In this article (Part One) we describe the initial battle and the phase of protecting life.All relatives go through the three phases. Family members who have already overcome previous set-backs get through the process slightly more quickly and experience less extreme emotions.Understanding the process of protecting in different phases may help health care professionals to do anything in their power to avoid unnecessary suffering, to ease the pain and to support family members in their task of protecting.

The identification and description of the basic psychological process linked with the focus of family members' functioning during the acute phase of traumatic coma.Earlier research learned that hope is a core category in coping with traumatic coma. Hope seems to be the drive to keep family members going and to enable them to fulfil their main task, namely protecting. In the two articles on the focus of family members functioning, this task is defined and the process linked with it is described.A qualitative approach according to the 'grounded theory' method.Twenty-four in-depth interviews with 22 family members of 16 patients with traumatic coma.Family members describe the period after the confrontation with traumatic coma as a battle. During this battle, they feel the urge to protect their relative in coma, other family members and themselves. They go through three phases: protecting life, protecting from suffering, protecting what remains to rebuild life. In this article (Part Two) we describe the phase of protecting from suffering and protecting what remains to rebuild life.All relatives go through the three phases. Family members who have already overcome previous set-backs get through the process slightly more quickly and experience less extreme emotions.Understanding the process of protecting in different phases may help health care professionals to do anything in their power to avoid unnecessary suffering, to ease the pain and to support family members in their task of protecting.

A 76-year-old woman presented acutely to the emergency room with clinical and X-ray features of intestinal obstruction. Contrastenhanced CT image of the abdomen demonstrated an abnormal ovoid soft tissue mass (Fig. A), located between the right pectineus and obturator externus muscles. The coronal (Fig. B) and sagittal (Fig. C) reconstruction revealed a loop of small intestine into the right side obturator canal area. Based on the radiological findings, the diagnosis of obturator hernia was made and confirmed at surgery.

A case is reported of a 20-year-old female presenting with confusion and progressive sensory aphasia. CT and MRI showed bilateral and symmetric acute necrosis of the basal ganglia and of the left temporal and occipital lobe, besides chronic spinocerebellar degeneration. The imaging findings suggested a mitochrondrial encephalopathy. Genetic examination confirmed a MELAS syndrome (mitochondrial myopathy, encephalopathy, lactate acidosis and stroke like episodes).

To make a development on the recent data of the literature concerning the functional anatomy of the lymphatic drainage of the breast, observed during interventions of sentinel lymph node biopsy; to compare the descriptive anatomy taking into consideration these new results.The population of our descriptive anatomical study is made-up of five patients. All the patients underwent a radical mastectomy during which, an injection of 2 ml of patented blue, realized at the periareolar area allowed to observe the glandular lymphatic vessels. Bibliographic researches were undertaken on Internet site of the National Library of Medicine and on Internet site of the library of anatomy (Faculté de médecine des Saints-Pères Paris).Lymphatic anatomy of the breast was described since more than one century starting from works undertaken on anatomical subjects. Recent works, completed during sentinel lymph node biopsy, enriched these descriptive data of new functional anatomical data on the lymphatic drainage of the breast. Thus, the superficial ways of lymphatic drainage already described by Sappey, drain the surface glandular parenchyma until in the axillary lymph node. A deep plexux described more recently by Hidden drain the deep glandular parenchyma until in the internal mammary lymph nodes and the axillary lymph nodes. The results of our in vivo study corroborated the descriptive and functional data ever known.Thanks to the sentinel lymph node biopsy technique, the descriptive anatomy described since 1885, grows rich by new functional data which make it possible on the one hand, to understand at best the descriptive anatomy, and on the other hand, to apprehend the lymphonodal metastatic risk in breast cancer. These recent data are of an interest real, as well anatomical as therapeutic, and constitute a interesting research orientation.

To retrospectively assess the efficacy of post-mastectomy re-irradiation for local relapse of breast cancer.Twenty patients, initially treated by conservative surgery and radiotherapy (50 Gy in 25 fractions over 5 weeks) were treated from 1998 to 2001 for a local relapse by salvage mastectomy and re-irradiation (either electron or photon beams). Mean age was 53 years (31-71). Reasons for re-irradiation were that the local relapses were inflammatory (4 pts), multifocal (5 pts), cutaneous (5 pts), involved the nipple (3 pts) or because the surgical margins (either muscle or skin) were involved (3 pts). The median dose of re-irradiation was 45 Gy (33-65) in 15 fractions over 33 days. Mean follow-up was 48 months (5-97).Fifteen patients remained free of a second local recurrence and 10 were still alive, without metastasis. Neither the dose of re-irradiation nor the irradiated surfaces were prognostic factors of local control (P = 0.877 and P = 0.424). Five patients developed radiation-induced pneumonitis without functional respiratory impairment. The incidence of pneumonitis seemed to be related to the biological dose of re-irradiation (P = 0.037). Other late complications occurred such as pigmentation changes (12 pts), telangiectasia (8 pts), chondritis (2 pts), parietal fibrosis (7 pts), rib fractures (4 pts), severe pain (11 pts) and lymphedema (2 pts). The increase in biological equivalent dose was highly statistically linked with the occurrence of disabling pain (P = 0.0123).Parietal re-irradiation achieves good and lasting local control with an acceptable rate of acute complications but with a risk of disabling late sequelae such as severe pain.

Breast cancer rarely occurs in very young women, its diagnosis and management could sometimes be difficult. Our aim is to analyse the epidemiological and clinicopathological features of a group of very young women and especially to evaluate the results of therapeutic strategy.We report a retrospective study conducted at the department of radiotherapy in Alexis-Vautrin Centre, concerning 30 patients agedor = 30 years in whom a diagnosis of invasive breast carcinoma was made between 1986 and 2001.Six patients had familial history of breast cancer. Palpable tumor was found in 90% of cases, the average size was 3.5 cm. Eleven patients presented with stage I, 11 presented with stage II, 6 presented with stage III and 2 presented with stage IV. Five cancers were diagnosed after pregnancy (average tumor size = 5.8 cm). Eleven patients received neoadjuvant chemotherapy and 23 (82%) of 28 operable cases of invasive malignancy underwent breast conservative surgery (BCS). We found an invasive ductal carcinoma with grade III in 13/27 cases and a nodal involvement in a half of cases, 11 patients of 26 had no expression of oestrogen receptor. The average follow-up was 5 years: six patients (20%) recurred locally (all of them were initially treated by BCS), four patients developed a contralateral breast cancer and three developed a second malignancy. Ten patients died of their metastatic disease. The 5-year overall survival rate was 78%.Our results are consistent with those of the published reports and suggest that very young women with breast cancer have a poorer prognosis compared with the older ones. They should receive, according to their prognostic factors, an appropriate regional, systemic and hormonal therapy.

Radiofrequency (RF) is a method of in situ destruction of liver tumor. Biliary complications are bile ducts stenosis or biliary abcess. The aim of this work was to study consequences of liver RF on bile ducts.A porcine model of biliary lesions was created using radiofrequency ablation liver. Twenty-two pigs were used for the study. The RF RITA 1500 generator (RITA Medical Systems, Mountain View, Calif., USA) was used for all experiments. The needle was positioned under sonographic control in liver parenchyma beside bile ducts. Two lesions were performed in left liver. Four groups of 5 pigs were treated. The pigs were sacrificed 1 or 3 weeks after the procedure. Pringle maneuver was utilized in half of the RF procedures. An ex vivo cholangiogram was obtained by direct injection into the main bile duct. Samples of RF lesions of liver parenchyma near and at a distance from the RF lesions were taken for pathological studies.Radiological lesions were biliary stenosis, with or without upstream bile duct dilatation, or complete interruption of the bile duct, or extravasation of the radiological contrast agent. Histological lesions of bile ducts were observed near RF lesions and at distance of the RF lesions when a Pringle maneuver was used or when the liver was removed after 3 weeks.RF ablation in contact of the intrahepatic bile duct induced biliary lesions. Therefore, it is required to stay away from the bile duct or to protect it when performing RF ablation.

We present a minimally invasive technique for tibial valgus osteotomy using a medial wedge composed of tricalcium phosphate.The bone substitute is composed of slowly resorbable tricalcium phosphate material shaped to the desired form and having mechanical properties allowing stable osteotomy via a short incision and staple fixation. Intraoperative fluoroscopy enables a reliable and reproducible technique. A lateral fixation staple is required because there is a risk the lateral hinge could break. This technique was used for 58 knees in 55 patients (mean age 47 years). According to the Ahlback classification of femorotibial degeneration, there were 43 grade I knees, 12 grade II, and 3 grade III.The implant was well tolerated in all cases. Bone healing was achieved in most cases without loss of the osteotomy angle. Complications were: rupture of the lateral hinge in four cases leading to nonunion in one, one low-grade infection. Implant resorption at mid term was significant: among the 22 patients with a follow-up of more than 5 years, the implant was barely visible in 18.This technique provides an easy way to achieve tibial valgus osteotomy without compromising future intervention. The technique can be considered to be minimally invasive because of the size of the incision, the minimal fixation required, and the bone sparing effect of the bone substitute.

MRI is now the method of choice for bone marrow imaging. The MR appearance of bone marrow is influenced by the relative amounts of its fatty or hematopoietic components. In the following study, we report different patterns in changes consistent with reconversion into hematopoietic tissue of fatty marrow that were observed in 3 patients who received hematopoietic growth factors in combination with their chemotherapy for musculo-skeletal tumors of lower limbs.

Ectopic breast tissue usually develops along the mammary ridge. The incidence of this anomaly has been reported as high as 6%. Malignant development is rare. A case of carcinoma of aberrant breast tissue, located in the axilla is described. Mammographies of the ectopic breast performed few years before the diagnosis of carcinoma are presented and also those done for the diagnosis of the tumor. A literature study was performed on carcinoma and ectopic breast tissue. Considering high frequence of node involvements for these cases, the optimal therapeutic strategies are discussed.

Because of its high incidence and the high number of deaths induced, breast cancers in elderly women is a major health problem. The diagnosis is often clinical and the tumors are often at advanced stage with many initial metastases due to some neglect. Breast cancer in elderly women has no specific radiological form and is more often infiltrating ductal carcinoma of SBR grade I. Hormonal receptors are generally higher in elderly than in young women. Surgery of breast cancers with equal anesthetic risks factors does not induce more complications in elderly women than in the general population. In 12% of cases, an associated pathology influences the decision (degradation of the respiratory or cardiovascular function or reduction of the renal function). Between 70 and 80 years, provided that life expectancy is compatible with radiotherapy, corollary to conservative treatments in the present state of our knowledge for tumors under 3 to 4 cm, there is an alternative between radiosurgical conservative treatment and modified mastectomy associated with axillary dissection. In case of bulky tumors (3 to 4 cm) and failure of the hormonal treatment or impossibility to perform a complementary radiotherapy treatment (for instance, senile dementia), of axillary node involvement, a fortiori if the tumor has no hormonal receptors, the modified mastectomy with axillary dissection remains the therapeutic standard. In case of bulky tumor, the hormonal status can be used to induce the patient to accept an operation and, if necessary, to perform a conservative surgery. However, despite hormonosensitivity of breast cancer, a tumoral progression after a mean duration of hormonosensitivity of 25 months is to be expected in 93% of the cases, included 25% in whom a complete response to hormonotherapy was observed. A fractionated irradiation delivering 2 Gy per fraction and 5 fractions per week with a total number of sessions of 25 gives better esthetical results. This optimal treatment lasts 5 weeks and the patients often get tired since they are old and their radiotherapy centre is far from their house. Therefore hypofractionated treatment (once a week) should be proposed. The adjuvant medical treatment of reference for menopausal women is hormonotherapy by tamoxifen. Breast cancer in elderly women reduces life expectancy at 5 years by 50%; the theoretical therapeutic indications are the same as for young women, but their application is adapted to the patient. It would be dangerous and illusive to undertreat such a disease when the life expectancy is longer than 3 years.

The study bears on 672 infiltrating carcinomas of the cervix treated from 1977 until the end of 1991, by a radiosurgical combination (311 patients) or by exclusive irradiation (361 patients). The radiosurgical series includes mostly stages IB and II and patients under 50 years because of the therapeutic protocol. Most of the patients aged over 50 years and all stages III were treated by exclusive irradiation. External beam irradiation was most often performed in 4 fields by linear accelerator of 12 and 25 MeV. Uterovaginal brachytherapy used the technique of molds. In 55 cases, a complementary interstitial brachytherapy was applied on residual node. A computer dosimetry was made for each patient with calculation of the doses delivered to organs at risk and to node areas (points of calculation ICRU n degrees 38). The results at 5 years are as follows for the total series: locoregional control (LRC) 79%, specific survival (SS) 73%, overall survival 70%. For stage I, the LRC of the radiosurgical series is 92%, that of the series of exclusive irradiation 87% (no significant difference, neither for SS if we consider the tumoral size); For stage II, the LRC is 70% in the radiosurgical series and 79% in the series of exclusive irradiation. There is no difference if proximal stage II is compared. Conversely, for distal stage II, the difference is very significant in favour of exclusive irradiation (LRC 31%/77%, SS 26%/70%, p0.006). If we consider the results according to age, the difference for distal stage II comes mostly from patients under 50 years and especially those aged 40 years or under. For stage III, the LRC is 61% for patients over 50 years and 34% for those aged 50 years or under (p = 0.006). As the nodes, the results of surgical pieces and lymphadenectomy are studied. The patients under 40 years in stages II and III present more metastases than others (p = 0.003). Among the therapeutic factors, the dose rate and the treatment duration were particularly studied. A detailed study of the complications is made for the radiosurgical series as for the series of exclusive irradiation according to the French Italian glossary of complications as well as a study of the factors inducing them.

The study includes 346 carcinomas of the oral cavity (244 mobile tongues and 102 floors of mouth) treated by brachytherapy alone at primary tumor. We noted 199 T1, 131 T2, 14 T3 and 2 TxNx. Among T1, 36 patients had a neck dissection as well as 73 T2. Brachytherapy was performed according to the Paris system. In 59 cases, the curage on the lesion side was a radical neck dissection, in 14 cases a functional neck dissection and in 45 cases a submaxillary and submental dissection. A combined controlateral neck dissection was performed in 20 cases. A complementary irradiation of the node areas was given in 28 cases.for T1, the local control (LC) is 96%, the locoregional control (LRC) 83%, the specific survival (SS) 88%, and the overall survival (OS) 73%. For T2, LC 85%, LRC 70%, SS 75%, OS 52%. For T3, LC 64%, LRC 44%, SS 25%, OS 18%. The difference is very significant between T1 T2 T3 (p0.006) for results concerning N0, it is not significant between the N1 in each category, but their number is too low to reach a degree of significancy. In the 36 neck dissection specimens of T1, we found only in 7 cases positive nodes and in the 73 specimens of T2, 24 cases of positive nodes. A detailed study is reported. Tumoral, node or both recurrences are summarized (see table IV). Node recurrences are more frequent in patients without neck dissection than in those with neck dissection for T1, T2, N0, but this is significant only for LRC, SS and OS between patients with negative nodes on neck dissection and those with positive nodes (p0.0001). No significant difference was found between OS and SS for patients T1, T2, N0 with positive systematic neck dissection and those with a neck dissection differed until the node recurrence. Among T1, T2, T3, we noted more metastases in patients who presented a recurrence than in others. In conclusion, for patients treated by brachytherapy alone to the primary lesion, it seems desirable to perform a systematic neck dissection if there are adenopathies on initial examination. The dissection can be delayed for small tumors T1 N0 and low T2 N0 if the patients are followed-up regularly. However, a systematic dissection must be advised for high T2 N0 and T3 N0 given the frequency of the node involvement and the risk of metastases.

Surgery is the golden standard of treatment of endometrial carcinoma. The risk of central or vaginal recurrences justifies adjuvant treatment.Brachytherapy for endometrial adenocarcinoma is given commonly as pre- or post-operative treatment. In case of medical contra-indications for surgery brachytherapy can be applied as the only treatment. Experience of the anticancer center Alexis Vautrin in Nancy of the years 1975 to 1988 is evaluated. Iridium-192 low-dose-rate (LDR) wires were used.Pre-operative brachytherapy was given with a vaginal mould applicator to 580 patients. The dose was 50 Gy at 0.5 cm below the surface of the vagina. The locoregional control rate was 93% after 5 years and the 5-year survival 82%. 139 patients received radiotherapy alone and no surgery. LDR-brachytherapy was given the upper third of the vagina and endometrium with an "umbrella" applicator. The locoregional control rate was 83% after 5 years and the survival rate 55%. 117 patients received a post-operative brachytherapy of the vagina. The locoregional control rate was 93% after 10 years and the survival rate 65%.A pre- and post-operative radiotherapy results in a reduction of the vaginal relapse rate. The LDR afterloading technique with primary radiotherapy of endometrial adenocarcinoma leads to a locoregional control slightly interior. The treatment results compare favourably with the best of the literature.

Eighty-five bladder cancers were treated at the Urology Clinic of Nancy and the Centre Alexis Vautrin from 1975 to 1992 with short course preoperative radiation therapy (3 x 3.5 Gy), conservative surgery and brachytherapy by iridium-192. The tumours were classified according to the 1979 UICC pTNM classification. There were 27 pT1, 31 pT2 and 22 pT3, two pT4 and three pTx. The pT1-pT2 cases received only one brachytherapy (50 Gy at least) after the short course preoperative irradiation. The pT3 cases received only 30 Gy of brachytherapy and an external irradiation boost (generally 40 Gy to the node areas and 30 Gy to the tumour, but the dose varied during the time course). Surgery was often preceded by an endoscopic resection consisting of a tumoral resection or a partial cystectomy according to the localisation. The plastic vector tubes were put into place at the time of partial cystectomy. Until 1983 the radioactive wires were loaded into the vector tubes on the day following surgery, thereafter it was done one week later. The 85 patients were classified into two groups: 63 patients who were untreated previously and 22 patients who had received one or more endoscopic resections for recurrences. The median follow-up was 84 months. The local controls at 5 years were 78% in the first group versus 56% in the second group (p = 0.005) with an overall survival of 73 and 65%, respectively. The local control did not vary according to the differentiation (grade 1/2 vs. grade 3). The local control for pT1, pT2, pT3 was 85, 64 and 70% with a specific survival of 85, 76 and 72%, and an overall survival of 78, 66 and 66%. Among early complications, delay in healing of the bladder wall with subsequent vesico-cutaneous fistula depends mainly on the loading time of radioactive wires after surgery and is rare if the loading is delayed by one week. The late complications depend mostly on dosimetric factors. We found 24 grade 1, three grade 2, four grade 3 and one grade 4. The following factors are significant: the surface treated (> 14 cm2), a distance between the sources of more than 2 cm and, especially, activity of the wires of more than 2 mCi/cm (this factor was found in the five complications of grade 3 and 4), the other factors were not significant in univariate analyses.

The specific heat of two ferrites with respective chemical composition Mn1-a Zna, Fe2 O4(a ≈ 0.38) and Ni1-a Zna Fe2 O4(a ≈ 0.50) has been measured with a Nernst adiabatic calorimeter in the temperature range 20°C–350°C. Associated with the ferrimagnetic transition an enhanced specific heat, due to the magnetic contribution, is observed, having a maximum at the Curie-point (172°C and 308.5°C respectively). The results of the measurements are tabulated and discussed.

Scintillators for the detection of slow neutrons were obtained by pressing mixtures of H3BO3 and ZnS(Ag) phosphor into thin, slightly transparent disks. In order to obtain optimal conditions, we studied the influence of mixing-ratio, thickness and pressure on detection efficiency. The scintillator obtained in this way was compared with a commercial NE 400 slow neutron boronpolyester detector.

Phenomena, due to the multipactor effect and observed in the linear electron accelerator of the Ghent University are reported. An explanation is proposed for the variation of the anomalous attenuation due to the multipactor effect as a function of the R.F. power fed in the accelerator.

A case of an anomalous left coronary artery originating from the pulmonary artery is described. The infant, 4 months old, died shortly after ligation of the aberrant vessel. Postmortem angiography demonstrated multiple, small anastomotic channels, with a cross section varying from 150 to 200 μ, between the right and left coronary arteries. The physiologic disturbances resulting from this anomaly are discussed briefly, and the differences between the infantile and adult types are stressed. It is suggested that the anomalous left coronary artery should only be ligated if a left-to-right shunt through it can be demonstrated by cardiac catheterization or aortography.