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The mammalian heart is characterized by the presence of striated myocytes, which allow continuous rhythmic contraction from early embryonic development until the last moments of life. However, the myocardium contains a significant contingent of leukocytes from every major class. This leukocyte pool includes both resident and nonresident immune cells. Over recent decades, it has become increasingly apparent that the heart is intimately sensitive to immune signaling and that myocardial leukocytes exhibit an array of critical functions, both in homeostasis and in the context of cardiac adaptation to injury. Here, we systematically review current knowledge of all major leukocyte classes in the heart, discussing their functions in health and disease. We also highlight the connection between the myocardium, immune cells, lymphoid organs, and both local and systemic immune responses.

BackgroundThe response of solid tumors such as papillary thyroid cancer (PTC) to immune checkpoint inhibitors (ICIs) is highly variable. The biological basis of this variability remains unknown.MethodsTo test the hypothesis that preconditioning of the immune system modulates the therapeutic effect of ICIs, we used a murine model where PTC and iodine exacerbated thyroiditis (IET) can be induced in a temporally predictable fashion. A total of 122 mice were divided into 3 experimental groups. In the first one, named concomitant IET and PTC (No.=40), IET, and PTC were induced at the same time; in the second one, named pre-existing IET (No.=44), IET was induced prior to the induction of PTC; in the third one, named no IET (No.=38), only PTC was induced. Following disease induction, mice of each group were treated with anti-PD-1 antibody, anti-lymphocyte activation gene 3 antibody (anti-Lag3), anti-T-cell immunoglobulin and mucin domain 3 antibody (anti-Tim3), or IgG control. Ten weeks after the initial ICI injection, mice were sacrificed to collect the thyroid gland for histological analysis, to quantify the incidence and burden of PTC, and to perform high-throughput single-cell RNA sequencing of infiltrating CD45+cells.ResultsIn the concomitant IET and PTC group, ICI treatment reduced PTC incidence (p=0.002 comparing treatment with any ICI vs control), while it had no effect in the pre-existing IET and no IET groups. Single-cell sequencing of thyroidal CD45+cells showed that the different ICIs tested had both specific and shared effects on all the components of the thyroidal immune cell infiltrate. The shared effect of the tested ICIs was dependent on the presence of pre-existing versus concomitant IET. In the context of concomitant IET, ICI treatment resulted in the modulation of a greater number of pathways related to both innate and adaptive immunity.ConclusionsResponse to ICIs depends on the status of the immune system of the treated individual. Modulation of the immune system should be explored as a tool to improve response to ICIs in patients with PTC or other forms of cancer.

A growing body of evidence shows that B-lymphocytes play an important role in the context of myocardial physiology and myocardial adaptation to injury. However, the literature reports contrasting data on the prevalence of myocardial B-cells. B-cells have been reported to be both among the most prevalent immune cells in the rodent heart or to be present, but at a markedly lower prevalence than myeloid cells, or to be quite rare. Similarly, several groups have described that the number of myocardial B-cells increases after acute ischemic myocardial injury, but one group reported no changes in the number of B-cells of the injured myocardium. Implementation of a shared, reproducible method to assess the prevalence of myocardial B-cells is critical to harmonize observations from different research groups and thus promote the advancement of the study of B-cell myocardial interactions. Based on our experience, the seemingly contrasting observations reported in the literature likely stem from the fact that murine myocardial B-cells are mostly intravascular and connected to the microvascular endothelium. Therefore, the number of B-cells recovered from a murine heart is exquisitely sensitive to the perfusion conditions used to clean the organ and to the method of digestion used. Here we report an optimized protocol that accounts for these two critical variables in a specific way. This protocol empowers reproducible, flow cytometry-based analysis of the number of murine myocardial B-cells and allows researchers to distinguish extravascular vs. intravascular myocardial B-cells.

Resume Objectifs Malgre les recommandations, le taux de femmes recevant une supplementation en acide folique en France est insuffisant. L’objectif principal etait d’identifier les facteurs associes une supplementation inadequate en acide folique. L’objectif secondaire etaient d’evaluer les connaissances des femmes sur la prevention des anomalies de fermeture du tube neural (AFTN). Methode Nous avons realise une enquete sur 400 femmes de 8 maternites parisiennes. La supplementation en acide folique etait definie comme inadequate lorsqu’elle etait debutee apres le debut de la grossesse. Resultats Parmi les femmes interrogees, 68 % avaient une supplementation inadequate en acide folique. Les facteurs associes a une supplementation inadequate etaient un âge inferieur a 35 ans (ORa = 1,8 ; 95 % IC [1,1–2,8]), l’absence de couverture sociale (ORa = 3,9 ; 95 % IC [1,5–10,1]), un niveau d’etude n’allant pas au-dela du baccalaureat (ORa = 2,9 ; 95 % IC [1,2–6,9]), et l’absence de suivi gynecologique regulier (ORa = 3,0 ; 95 %IC [1,6–5,6]). Plus de la moitie (55,5 %) des femmes de l’etude n’avaient pas une bonne connaissance des benefices de l’acide folique et les facteurs associes etaient l’absence de suivi gynecologique regulier et l’absence de couverture sociale. Conclusion Des facteurs individuels associes a un defaut de supplementation ont ete identifies. Ces resultats apportent aux professionnels et tutelles de sante des elements utiles pour developper des strategies adaptees a certains sous-groupes de femmes pour une meilleure prevention des AFTN dans ces populations.

Introduction/Objective The genetic etiology of autism spectrum disorders is only partially understood. Here we describe a 16-year-old male diagnosed with autism at two years of age. He has dysmorphic features, severe cognitive disability, and history of cryptorchidism. A review of systems was significant for slightly coarse features overall, with deep-set eyes, pinched nasal bridge with wide nasal tip, and widely spaced teeth. A large pectus excavatum deformity was also noted. Although the parent’s genetic testing concluded that this likely represents de novo mutation, it is worth mentioning that our patient has a 13-year-old female maternal first cousin with learning difficulties that were said to be less severe. There is no other family history of autism. Methods/Case Report Chromosome analysis showed an abnormal karyotype identifying a duplication of the short arm of chromosome 3 from p13 to p14.3, 46,XY,dup(3)(p13p14.3). Additional microarray testing confirmed this duplication and defined the size as 14.9 Mb. Regions of homozygosity of 29.8 Mb were also identified, representing about 1% of the autosomal genome. The duplicated area includes over 70 genes, thirteen of which are known Mendelian disease genes (IL17RD, HESX1, APPL1, FLNB, DNASEIL3, PDHB, ACOX2, ATXN7, SLC25A26, EOGT, LMOD3, MITF, and FOXP1). Duplications of 3p are extremely rare and can be de novo or inherited from a parent with a balanced translocation. Individuals with these better-described chromosome 3p duplications typically present with intellectual and developmental disabilities, such as autism, as 3p duplications typically present with intellectual and developmental disabilities, such as autism and distinctive dysmorphic features. This duplication has never been reported as a known syndrome and has minimal overlap with copy number variants (CNVs) among healthy individuals. Results (if a Case Study enter NA) NA Conclusion Autism spectrum disorders are largely characterized by speech, communication, and social impairment of varying degrees. Diagnosis is typically made on clinical grounds, but in 14-35% of cases, a genetic basis for the disorder, typically either due to a single gene disorder or a chromosomal deletion/duplication, may be found. This case report describes a rare finding of a 14.9 Mb interstitial duplication on chromosome 3p.

Despite the guidelines in effect, too few women in France receive folic acid supplementation. The principal objective of this study was to identify the factors associated with the inadequacy of this supplementation in the periconceptional period. The secondary objective was to assess women's knowledge about the prevention of neural tube defects (NTDs).This study included 400 women and took place in 8 Parisian maternity. Folic acid supplementation was inadequate when started after the beginning of the pregnancy.Among the women questioned, 68% had inadequate folic acid supplementation. They were significantly younger (ORa= 1,8; 95% IC [1,1-2,8]), didn't had health insurance (ORa=3,9; 95% IC [1,5-10,1]), had not studied after high school (ORa=2,9; 95% IC [1,2-6,9]) and had regular gynecological care less often than the women with adequate supplementation (ORa=3,0; 95% IC [1,6-5,6]). More than half (55.5%) had insufficient knowledge of the benefits of folic acid; the factors related to this lack of knowledge were the absence of regular gynecological care and of health insurance.Individual factors associated with a lack of supplementation have been identified. These results provide health professionals and supervisors with useful information for developing strategies adapted to certain subgroups of women for better prevention of AFTN in these populations.

International audience; Prostate cancer (PCa) pelvic radiotherapy fields are defined by guidelines that do not consider individual variations in lymphatic drainage. We examined the feasibility of personalized sentinel lymph node (SLN)-based pelvic irradiation in PCa. Among a SLN study of 202 patients, we retrospectively selected 57 patients with a high risk of lymph node involvement. Each single SLN clinical target volume (CTV) was individually segmented and pelvic CTVs were contoured according to Radiation Therapy Oncology Group (RTOG) guidelines. We simulated a radiotherapy plan delivering 46 Gy and calculated the dose received by each SLN. Among a total of 332 abdominal SLNs, 305 pelvic SLNs (beyond the aortic bifurcation) were contoured (mean 5.4/patient). Based on standard guidelines, CTV missed 67 SLNs (22%), mostly at the common iliac level (40 SLNs). The mean distance between iliac vessels and the SLN was 11mm, and despite a 15mm margin around the iliac vessels, 9% of SLNs were not encompassed by the CTV. Moreover, 42 SLNs (63%) did not receive 95% of the prescribed dose. Despite a consensus on contouring guidelines, a significant proportion of SLNs were not included in the pelvic CTV and did not receive the prescribed dose. A tailored approach based on individual SLN detection would avoid underdosing pelvic lymph nodes that potentially contain tumor cells.

OBJECTIVES Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P

Background In current practice, anterior cruciate ligament (ACL) tears can be diagnosed using several devices to measure anterior tibial translation and rotational knee laxity, but these measures are never collected together. The Rotab®, which yields simultaneous measurements of anterior tibial translation and passive lower limb rotation under stress, would therefore be advantageous in current practice, but its reliability has never been tested. Aim of study To evaluate the accuracy and reliability of the Rotab® compared to the reference system, radiostereometric analysis (RSA). Methods This anatomical study was conducted on 14 lower limbs collected from fresh cadavers. Simultaneous measurements of anterior tibial translation and rotation were obtained with both systems, with antero-posterior (AP) forces of 134N and 250N using the Rotab®. Measurements were made on intact ACL and then repeated after ACL section. Variables were analyzed in univariate analysis by ANOVA, and the intraclass correlation coefficient (ICC) between the systems was determined by the Bland and Altman method. Results The difference between the two methods for evaluating anterior tibial translation was 0.05±0.98mm at 134N and 0.29±1.04mm at 250N. The correlation between the tests was high (r 134 =r 250 =0.97, p=0.8). The difference between the two methods for rotational laxity was 0.69±2.7° at 134N and 0.5±0.6° at 250N. The Rotab® showed a significant difference only at 250N for rotational laxity after the ACL tear. Conclusion The Rotab® is a reliable device to measure rotational laxity coupled with anterior translation of the knee.

International audience; PURPOSE: To evaluate the therapeutic impact of (18)F-fluorocholine (FCH) PET/CT in biochemical recurrent prostate cancer (PC) and to investigate the value of quantitative FCH PET/CT parameters in predicting progression-free survival (PFS).METHODS: This retrospective study included 172 consecutive patients with PC who underwent FCH PET/CT for biochemical recurrence. Mean rising PSA was 10.7 ± 35.0 ng/ml. Patients with positive FCH PET were classified into three groups: those with uptake only in the prostatic bed, those with locoregional disease, and those with distant metastases. Referring physicians were asked to indicate the hypothetical therapeutic strategy with and without the FCH PET/CT results. Clinical variables and PET parameters including SUVmax, SUVpeak, SUVmean, total lesion choline kinase activity (TLCKA) and standardized added metabolic activity (SAM) were recorded and a multivariate analysis was performed to determine the factors independently predicting PFS.RESULTS: In 137 of the 172 patients, the FCH PET/CT scan was positive, and of these, 29.9 % (41/137) had prostatic recurrence, 42.3 % (58/137) had pelvic lymph node recurrence with or without prostatic recurrence, and 27.7 % (38/137) had distant metastases. The FCH PET/CT result led to a change in treatment plan in 43.6 % (75/172) of the 172 patients. Treatment was changed in 49.6 % (68/137) of those with a positive FCH PET/CT scan and in 20 % (7/35) of those with a negative FCH PET/CT scan. After a median follow-up of 29.3 months (95 % CI 18.9 - 45.9 months), according to multivariate analysis age

Resume L’objectif de cette etude est d’evaluer les liens entre les dysfonctionnements executifs et les troubles de la communication chez les personnes atteintes de la maladie d’Alzheimer (MA). Seize patients residant dans un etablissement pour personnes âgees dependantes (EHPAD) ont ete selectionnes pour cette recherche. Tous les sujets avaient un score au Mini-Mental State Examination (MMSE) entre 10 et 20 et un score a l’epreuve de denomination DO 80 situe dans la norme (±2 ET). Les capacites de communication ont ete evaluees au moyen de la Grille d’evaluation des capacites de communication (GECCO) ; la Batterie rapide d’evaluation frontale (BREF) a ete utilisee pour mesurer le fonctionnement executif. Les resultats demontrent que les troubles de l’inhibition sont correles au manque de coherence globale du discours des patients ainsi qu’a l’absence de feed-back a l’interlocuteur. Il apparait egalement que l’absence de progression rhematique et de feed-back a la situation est liee a un deficit de la flexibilite mentale. En conclusion, la preservation des fonctions executives est un facteur important au maintien d’une communication efficiente. Leur prise en charge precoce pourrait ainsi permettre de retarder l’apparition des troubles communicationnels.

Lymph node metastasis is an important prognostic factor in prostate cancer (PC). The aim of this prospective study was to validate, through laparoscopic surgery, the accuracy of the isotopic sentinel lymph node (SLN) technique correlated with hyperextensive pelvic resection (extended pelvic lymphadenectomy dissection) in patients with localized PC, candidates for local curative treatment. Methods: A transrectal ultrasound-guided injection of 99mTc-sulfur rhenium colloid (0.3 mL/100 MBq) in each prostatic lobe was performed the day before surgery. Detection was performed intraoperatively with a laparoscopic probe, followed by extensive resection. SLN counts were performed in vivo and confirmed ex vivo. Histologic analysis was performed by hematoxylin-phloxine-safran staining, followed by immunohistochemistry if the SLN was free of metastasis. Results: Two hundred three patients with PC at intermediate or high risk of lymph node metastases were included. The intraoperative detection rate was 96% (195/203). Thirty-five patients had lymph node metastases, 19 only in the SLN. The false-negative rate was 8.5% (3/35). Unilateral surgical SLN detection did not validate bilateral pelvic lymph node status, and extended pelvic lymphadenectomy dissection was necessary on the opposite side of detection to minimize the false-negative rate (2.8% [1/35]). A significant metastatic sentinel invasion in the common iliac region existed (9.3%) but was always associated with other metastatic node areas. The internal iliac region was the primary metastatic site (40.7%). Finally, this series invalidated any justification for a standard or limited dissection, which would have missed 51.9% and 74.1% of lymph node metastases, respectively. Conclusion: The radioisotope SLN identification method up to the common iliac region is successful to identify sentinel nodes during laparoscopic surgery per hemipelvis to be acceptably considered as an isolated procedure and should be validated for intermediate- and high-risk patients.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 6 - p. 541-549

Objectives Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder with manifestations mainly involving the skeletal, ocular, and cardiovascular systems. The phenotypic variability observed in MFS makes genetic counselling difficult. Prenatal diagnosis (PND) and preimplantation genetic diagnosis are technically feasible when a causal mutation is identified, but both raise many ethical questions in this condition. Little is known about opinions and practices in such reproductive issues in MFS. The goal of this study was to report on patients' points of view and geneticists' standard practices. Methods Two different questionnaires were produced. Results Fifty geneticists filled in the questionnaire. Twenty-two per cent thought that PND was acceptable, 72% debatable and 6% not acceptable. Preimplantation genetic diagnosis was more often reported acceptable (34% of answers). Results varied according to the physician's experience with the disease. Fifty-four answers were collected for patients' questionnaires. Most of them (74%) were favourable to the development of prenatal testing, and believed that the choice should be given to parents. However, only a minority would opt for prenatal diagnosis for themselves. Conclusion This study showed that the majority of patients were in favour of PND and that opinions among practitioners varied widely, but that overall, practitioners favoured a systematic multidisciplinary evaluation of the couple's request. © 2012 John Wiley & Sons, Ltd.

SummaryPreambleArthroscopic repair is our treatment of choice for massive rotator cuff tears. In order to reduce tension, we perform a side-to-side suture technique. The purpose of our work was to study the outcome of such technique by evaluating functional score and rotator cuff integrity using ultrasound at 2-year follow-up.HypothesisThe “side-to-side” arthroscopic repair of large and massive rotator cuff tears provides a long-term continuity of rotator cuff mechanism, enhances function and relieves pain with low morbidity.Type of studyRetrospective monocenter study.Material and methodsWe included a continuous series of 50 patients of mean age 66.6 years (46–80), operated on between January 2007 and March 2008 for full-thickness retracted tears of the supraspinatus extending or not to the infraspinatus tendon. Management consisted of arthroscopic subacromial bursectomy, acromioplasty and side-to-side repair of the rotator cuff tendons with secure anchor fixation to the tuberosity. The relative Constant score was used for clinical evaluation preoperatively and at a minimum of 24 months after surgery. The continuity of rotator cuff mechanism was evaluated using ultrasound.ResultsThe mean relative Constant score improved significantly (p

Resume Objectifs L’atteinte ganglionnaire metastatique est un facteur pronostique important dans le cancer de la prostate (PC). Le but de cette etude prospective etait d’evaluer la pertinence de la technique du ganglion sentinelle par voie laparoscopique dans la stadification locoregionale chez les patients avec PC cliniquement localise. Patients et methodes Une injection par voie transrectale echoguidee de 0,3 mL/100 MBq de 99mTc-sulfure de rhenium colloidal dans chaque lobe prostatique a ete realisee la veille de l’intervention. La radiodetection peroperatoire etait realisee avec une sonde laparoscopique (Clerad® Gamma Sup) suivie d’un curage extensif. Les comptages des GS etaient realises in vivo et confirmes ex vivo. L’analyse anatomopathologique etait realisee par hematoxyline-phloxine-safran et suivie d’un immunomarquage si GS indemnes. Resultats Soixante-dix patients ayant d’un cancer de la prostate a risque intermediaire ou eleve de metastases ganglionnaires ont ete inclus. Le taux de detection peroperatoire etait de 68/70 (97,0 %). Quatorze patients avaient des metastases ganglionnaires, six uniquement dans les GS. Le taux de faux-negatifs etait de 2/14 (14,0 %). La region iliaque interne etait le premier site metastatique (40,9 %). Une atteinte sentinelle metastatique de la region iliaque commune au-dela du croisement ureteral etait presente dans 18,2 %. Un curage limite ou standard aurait ignore respectivement 72,7 % et 59,0 % des metastases ganglionnaires. Conclusion La voie laparoscopique etait adaptee a un large reperage des GS et un curage cible de ces ganglions limitait significativement le risque chirurgical du curage etendu tout en maintenant la precision de l’information.

Objectifs Rapporter les modifications engendrees par l’utilisation du protoxyde d’azote (N2O) durant l’anesthesie generale dans le cadre d’un traitement par HIFU (Focal One) en premiere intention chez des patients presentant un cancer de prostate localise. Les donnees quantitatives ont ete analysees par un test t de Student. Methodes De septembre 2015 a decembre 2016, 99 patients ont ete traites en premiere intention par HIFU avec le systeme Focal One pour un adenocarcinome prostatique. L’intervention a ete realisee soit avec l’utilisation d’un melange de protoxyde d’azote/oxygene (N2O/O2 : 50 %/50 %), soit sans utilisation de N2O. Nous avons analyse les differents parametres du traitement par HIFU : duree d’intervention et vitesse du traitement (volume traite par heure), nombre et duree des pauses, et variation du PSA postoperatoire a 1, 3 et 6 mois. Les donnees quantitatives ont ete analysees par un test t de Student. Resultats Les caracteristiques de la population et du traitement sont presentees dans le Tableau 1 . A volume prostatique similaire, la duree moyenne d’intervention etait significativement plus courte en l’absence de N2O et la vitesse de traitement etait significativement plus elevee en l’absence d’utilisation de N2O (p Fig. 1 ). Conclusion L’utilisation du N2O semble diminuer l’efficacite du traitement par HIFU, en augmentant les phenomenes de cavitation, entrainant l’augmentation de la duree du traitement, le nombre et la duree des pauses. Il semble exister une moins grande efficacite du traitement par HIFU sur le plan carcinologique avec diminution moins importante du PSA postoperatoire.

Resume L’emotion etant la resultante de plusieurs composantes, on s’est interroge sur les consequences de l’atteinte de la composante cognitive dans la prise de conscience de l’emotion. Comment une emotion sera-t-elle ressentie chez des sujets atteints de maladie d’Alzheimer ? Quelle influence le ressenti plus ou moins conscient des emotions chez ces sujets aura-t-il sur leurs capacites cognitives et communicationnelles ? Dans une recherche portant sur une population de 152 patients atteints de maladie d’Alzheimer, nous avons notamment evalue la verbalisation de l’emotion au cours de plusieurs situations de communication. Les resultats montrent l’influence de l’emotion sur les capacites de communication des malades Alzheimer : elle est souvent clairement verbalisee, exprimee, au sein du discours des malades mais elle montre aussi son influence a travers la qualite des performances communicationnelles des malades selon differents contextes de communication.

Resume Objectifs Le curage standard est actuellement remis en question dans la prise en charge du cancer de la prostate. Le but de cette etude prospective est d’evaluer les performances de la technique du ganglion sentinelle (GS) par cœlioscopie chez des patients porteurs d’un cancer localise de prostate candidats a un traitement local. Patients et methodes Les patients etaient injectes par voie transrectale echoguidee avec 0,3 mL/100MBq de 99 m Tc-sulfure de rhenium colloidal dans chaque lobe prostatique la veille de l’intervention. Une lymphoscintigraphie etait realisee deux heures apres. La radiodetection peroperatoire etait realisee avec une sonde cœlioscopique (Clerad ® Gamma Sup) suivie d’un curage extensif. Les comptages des GS etaient realises in vivo et confirmes ex vivo. L’analyse anatomopathologique etait realisee par HPS, suivie d’un immunomarquage si GS indemnes. Resultats Soixante-dix patients, porteurs d’un cancer de la prostate a risque intermediaire ou eleve de metastases ganglionnaires (D’Amico), PSA median 9,5 ng/mL [6–130] ont ete inclus dans l’etude. Le taux de detection lymphoscintigraphique a ete de 94,2 % (66/70) et peroperatoire de 97,0 % (68/70). Quatorze patients presentaient des metastases ganglionnaires, six uniquement dans les GS. Le taux de faux negatifs etait de 2/14 (14,0 %). La region iliaque interne est le premier site metastatique (40,9 %). Un curage limite ou standard aurait ignore respectivement 72,7 % et 59,0 % des metastases ganglionnaires. Conclusion La voie cœlioscopique est adaptee a un large reperage des GS et un curage cible de ces ganglions limiterait significativement le risque chirurgical du curage etendu tout en maintenant la precision de l’information.

Resume En France, la demence de type Alzheimer touche 850 000 personnes actuellement. Il est donc primordial d’apporter de nouvelles approches therapeutiques afin d’aider cette population en constante evolution. Parmi elles, la therapie ecosystemique applique une approche cognitivocomportementale aupres du patient, tout en apportant un soutien ecologique sur les moyens de communication a son entourage. Afin d’estimer l’interet de cette therapie, nous avons utilise le Rivermead Behavioral Memory Test (RBMT III), outil evaluant la memoire ecologique, pour comparer une population A composee de cinq patients MMS inferieur a 14 ayant suivi une therapie ecosystemique, a une population B de cinq patients egalement de memes stades, n’ayant pas ete pris en charge. Notre etude a revele que la population A avait obtenu des scores superieurs a ceux de la population B dans la majorite des epreuves. Enfin, la population A, ayant de meilleurs scores aux epreuves differees que la population B, semble garder les informations plus longtemps en memoire. Cette etude nous a donc montre que l’approche ecosystemique ameliore les capacites mnesiques. Cela nous permet de poser l’hypothese selon laquelle une therapie ecologique de la communication influerait sur les capacites cognitives a plus long terme.

Resume Objectifs Evaluer l’impact de l’augmentation de l’âge des meres et du diagnostic prenatal sur la prevalence de la trisomie 21 dans un echantillon de la population francaise. Patients et methodes Les donnees sur la trisomie 21 ont ete obtenues a partir du registre de malformations congenitales REMERA entre 1978 et 2005. La population surveillee correspond a environ 10 % des naissances francaises. Nous avons etudie la prevalence totale, la prevalence des naissances vivantes ainsi que la prevalence des interruptions de grossesse apres diagnostic prenatal positif. Resultats L’âge moyen des meres a augmente passant de 26 a 30 ans sur la duree de l’etude. La prevalence totale de la trisomie 21 est passee de 14/10 000 en 1978 a 23/10 000 naissances vivantes en 2005. L’augmentation progressive du nombre d’interruption de grossesse apres diagnostic prenatal atteint 78 % des cas en 2005. La prevalence a la naissance a diminue, passant de 14/10 000 en 1978 a 5,1/10 000 en 2005. Conclusion Il est important de continuer la surveillance epidemiologique de la trisomie 21 en France, notamment du fait des changements dans les caracteristiques demographiques de la population mais egalement dans les politiques de depistage prenatal de la trisomie 21.

Resume Objectifs Evaluer l’impact des facteurs demographiques tels que l’âge des meres sur la prevalence attendue de la trisomie 21 a la naissance. Patients et methodes Nous avons utilise les donnees demographiques nationales francaises colligees par l’Insee portant sur les naissances vivantes ainsi que sur l’âge des meres. La prevalence attendue a la naissance est calculee a partir d’un modele mathematique de regression logistique largement utilise dans le depistage serique de la trisomie 21 fœtale par le dosage des marqueurs seriques maternels. Resultats Nous presentons des donnees continues de prevalence attendue a la naissance sur une large periode qui s’etend de 1965 a 2008. Durant les trois dernieres decennies, l’âge moyen des meres a augmente de quatre annees, entrainant un doublement de la prevalence attendue de la trisomie 21 a la naissance, passant de 12,1 pour 10 000 naissances vivantes en 1977 a 21,7 pour 10 000 a 2008. Conclusion Il est important de continuer a prendre en compte l’impact des modifications de facteurs demographiques tels que l’âge maternel, notamment dans le cadre de l’evaluation des pratiques et des strategies de depistage de la trisomie 21.

Objectives Testicular metastases of prostate cancer are rare, usually clinically silent and present in the late stage of disease. We present the case of a patient with a solitary right testicular metastasis of a prostate cancer Gleason score 5 detected by 18 F Choline PET/CT, 16 yrs after total prostatectomy and 6 yrs after surgery of a left testicular metastasis. Material and methods A 80-year-old patient was directed to our department with a biochemically relapse of a prostate carcinoma. He had a laparoscopic prostatectomy in 2000, at age 65. Two 2 mm microcarcinomas of prostate cancer at the right base and apex and a left middle carcinoma of 8 mm were found. The Gleason score was 5. There was an extracapsular extension and the tumor was classified pT3a. Eight month after surgery the PSA was 0.08 ng/ml. In 2004 a rising PSA was observed, 0.48 ng/ml, and a salvage prostate bed radiotherapy was performed, with PSA nadir 0.24 ng/ml. The patient was then treated with intermittent hormonal therapy until July 2010, when he presented with a large left testicle. The PSA was 2.35 ng/ml. The ultrasonography found multiples left testicular nodules. Surgery was performed and histopathology confirmed a 6 × 4-cm testicular metastasis of the prostate carcinoma with extension to the rete testis and to the epididymis and with lymphatic emboli. Post-surgery the PSA dropped at 0.59 ng/ml and 10 months later it was 0.28, with a nadir of 0.21 in November 2011. The patient did not have additional treatment. A new biochemically relapse was diagnosed in March 2016, PSA 5.25 ng/ml, PSA DT 3.89 months, velocity 4.03 ng/ml/year, and the patient was addressed to our department. F Choline TEP/CT was performed after injection of 165 MBq 18 F Choline, 2.9 MBq/kg, with a dynamic phase of 10 minutes at the pelvis level, followed by an acquisition from the upper thigh to the base of skull. Results The 18 F Choline TEP/CT detected a high uptake on the right testicle, SUV max = 8, without other suspect lesions. Surgery was performed and the histology confirmed a new 4 cm testicular metastasis of the known prostate carcinoma. Post-surgery the PSA level was undetectable. Conclusion TEP F Choline is highly reliable in the detection of prostate carcinoma recurrence as in the case we present of a rarely solitary testicular metastasis of prostate cancer Gleason score 5. The testicles have to be well included on PET/CT field of view in order not to overlook such atypical metastases.

Resume Cet article presente une etude portant sur l’influence des facteurs « âge » et « theme de la conversation » sur les competences communicatives de 33 sujets âges sains repartis en trois tranches d’âge : 55–69 ans, 70–84 ans et 85 ans et plus. Il propose egalement une normalisation de la grille d’evaluation des capacites de communication des patients atteints de demence de type Alzheimer (Gecco) de Rousseau. Pour finir, une comparaison des profils communicationnels d’une population Alzheimer et d’une population saine est envisagee.

Resume Dans la litterature, les troubles du comportement du sujet âge dement, telles que l’agitation, l’agressivite, sont la consequence de la deterioration du fonctionnement cognitif. Si cette perspective est importante, elle sous-estime l’influence du milieu dans la survenue de ces comportements. Ainsi, nous pouvons penser que certaines conduites dites perturbatrices du patient dement sont produites en reponse a un certain contexte. En ce sens, elles ont une valeur communicante, c’est-a-dire que le sujet âge dement interagit avec l’environnement et que ses conduites temoignent d’une intentionnalite. Cette etude, realisee aupres de 20 personnes atteintes d’une demence de type Alzheimer vivant en institution specialisee, a pour objet d’identifier des situations ou le sujet reagit a son environnement. La mise en place d’une grille d’observation a permis d’apprehender la reactivite comportementale des sujets âges dements dans plusieurs situations de la vie quotidienne. Apres une presentation globale des resultats, les etudes de cas soulignent une variabilite interindividuelle importante ou a niveau de deficit cognitif comparable, les modulations du contexte font produire aux personnes des comportements tres differents.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 6 - p. 589-596

International audience; Aim In intermediate- or high-risk prostate cancer (PC) patients, to avoid extended pelvic lymph node dissection (ePLND), the updated Briganti nomogram is recommended with the cost of missing 1.5 % of patients with lymph node invasion (LNI). Is it possible to reduce the percentage of unexpected LNI patients (nomogram false negative)? We used the isotopic sentinel lymph node (SLN) technique systematically associated with laparoscopic ePLND to assess the potential value of isotopic SLN method to adress this point. Methods Two hundred and two consecutive patients had procedures with isotopic SLN detection associated with laparoscopic ePLND for high or intermediate risk of PC. The area under the curve (AUC) of the receiver operating characteristics (ROC) analysis was used to quantify the accuracy of different models as: the updated Brigantinomogram, the percentage of positive cores, and an equation of the best predictors of LNI. We tested the model cutoffs associated with an optimal negative predictive value (NPV) and the best cutoff associated with avoiding false negative SLN detection, in order to assist the clinician’s decision of when to spare ePLND. Results LNI was detected in 35 patients (17.2 %). Based on preoperative primary Gleason grade and percentage of positive cores, a bivariate model was built to calculate acombined score reflecting the risk of LNI. For the Briganti nomogram, the 5 % probability cutoff avoided ePLND in 53 % (108/202) of patients, missing three LNI patients (8.6 %), but all were detected by the SLN technique. For our bivariate model, the best cutoff was

Objectifs Le statut du ganglion sentinelle (GS) est pronostique du curage ganglionnaire loco-regional dans le cancer de la prostate mais ce statut a-t-il un impact sur l’evolution clinique des patients ? Le but de cette etude est d’analyser les donnees de survie de patients ayant beneficies d’une prostatectomie radicale cœlioscopique avec reperage des GS et curage pelvien extensif. Methodes De juin 2008 a decembre 2014, 227 patients consecutifs ont ete inclus, dont 49 patients (21,58 %) porteurs de metastases ganglionnaires. Le suivi median etait de 3,94 ans [3,72–4,23]. La survie sans recidive (SSR) et la survie globale (SG) ont ete analysees selon Kaplan–Meier et differents parametres histopathologiques par analyse uni- et multivariee (analyse par Cox regression). Resultats Une moyenne de 26,4 ± 10,5 ganglions retires lors du curage extensif, dont 5,72 ± 3,75 GS. Au dernier suivi, 24,9 % (62/227) des patients avaient recidive et 2 etaient decedes specifiquement du cancer prostatique. En analyse univariee, le stade clinique, le score de Gleason, le % biopsies positives et les marges chirurgicales affectaient significativement la SSR ( p −4 a 10 −6 ). En cas d’atteinte ganglionnaire metastatique, les donnees les plus significatives etaient le nombre total de ganglions metastatiques (GS et non GS) et la presence de macro-metastases ganglionnaires dans le GS ( p −12 a 10 −15 ). En analyse multivariee, la presence de micro- ou de macrometastases dans les GS (quelque soit l’atteinte non GS) etait le critere pronostique le plus pejoratif de la SSR, avec un hazard ratio de 5,25 [95 % CI : 2,83–9,74] ( p −6 ). Conclusion Le GS dans le cancer de la prostate localise semble etre porteur d’informations decisives de l’evolution clinique des patients puisqu’une atteinte metastatique GS a un impact important sur la SSR. Ceci souleve la question d’un traitement adjuvant plus precoce pour les patients avec atteinte metastatique des GS1.

Resume Cette recherche traite de la capacite d’imitation chez la personne atteinte de demence de type Alzheimer (DTA) au moyen de la relaxation, avec l’objectif therapeutique d’agir sur l’anxiete du malade. A partir des concepts de l’anxiete, de la relaxation et ses methodes et, enfin, de l’imitation (l’echoisation), nous avons emis l’hypothese que des seances de relaxation pouvaient avoir des effets sur l’anxiete en considerant que l’imitation pouvait etre un mode de transmission d’un etat emotionnel a une personne Alzheimer. Apres des seances de relaxation en contexte cadre et en contexte d’urgence, et l’evaluation de ces seances et de l’etat d’anxiete grâce a l’elaboration de grilles, nous avons pu montrer l’existence chez le patient dement d’une reelle capacite a se relaxer en imitant le comportement d’autrui. La possibilite de relaxer une personne demente par transmission d’un etat emotionnel grâce a la preservation de l’imitation archaique et de la memoire procedurale semble ainsi demeurer.

To evaluate the therapeutic impact of (18)F-fluorocholine (FCH) PET/CT in biochemical recurrent prostate cancer (PC) and to investigate the value of quantitative FCH PET/CT parameters in predicting progression-free survival (PFS).This retrospective study included 172 consecutive patients with PC who underwent FCH PET/CT for biochemical recurrence. Mean rising PSA was 10.7 ± 35.0 ng/ml. Patients with positive FCH PET were classified into three groups: those with uptake only in the prostatic bed, those with locoregional disease, and those with distant metastases. Referring physicians were asked to indicate the hypothetical therapeutic strategy with and without the FCH PET/CT results. Clinical variables and PET parameters including SUVmax, SUVpeak, SUVmean, total lesion choline kinase activity (TLCKA) and standardized added metabolic activity (SAM) were recorded and a multivariate analysis was performed to determine the factors independently predicting PFS.In 137 of the 172 patients, the FCH PET/CT scan was positive, and of these, 29.9 % (41/137) had prostatic recurrence, 42.3 % (58/137) had pelvic lymph node recurrence with or without prostatic recurrence, and 27.7 % (38/137) had distant metastases. The FCH PET/CT result led to a change in treatment plan in 43.6 % (75/172) of the 172 patients. Treatment was changed in 49.6 % (68/137) of those with a positive FCH PET/CT scan and in 20 % (7/35) of those with a negative FCH PET/CT scan. After a median follow-up of 29.3 months (95 % CI 18.9 - 45.9 months), according to multivariate analysis age70 years, SAM ≥23 and SUVmean ≥3 were parameters independently predicting PFS. A nomogram constructed using the three parameters showed 49 months of PFS in patients with the best scores (0 or 1) and only 11 months in patients with a poor score (score 3).This study indicates that a positive FCH PET result in PC patients with biochemical recurrence predicts a shorter PFS and confirms the major impact of the FCH PET result on the management of biochemical recurrent PC.

Objectifs Evaluer l’interet de l’utilisation d’un masque sensoriel d’auto-hypnose (HYPNOS Pro) lors de la realisation d’une fibroscopie vesicale en soins externes afin de diminuer l’anxiete du patient et la sensation douloureuse de l’examen. Methodes Etude prospective de mars a mai 2016. Nous avons propose au patient lors de la consultation la possibilite de beneficier d’un masque sensorielle d’auto-hypnose durant la realisation d’un examen endoscopique (fibroscopie vesicale associee a une anesthesie locale ± masque d’auto-hypnose). L’IDE de la consultation etait formee a la communication hypnotique. Nous avons evalue la connaissance du patient sur l’hypnose, son niveau d’anxiete avant et apres l’examen, la satisfaction du patient lors de l’utilisation du masque et son interet dans la procedure endoscopique. Resultats Quarante-cinq patients ont ete inclus pour cette etude. Vingt-neuf patients ont souhaite utiliser le masque sensoriel HYPNOS Pro ( Figure 1 ). Chez plus de 60 % des patients, l’utilisation du masque d’auto-hypnose a permis de diminuer l’anxiete liee au geste endoscopique. Ce geste est alors considere comme legerement ou nullement anxiogene chez pres de 96 % des patients utilisant le masque contre seulement 75 % des patients sans masque d’auto-hypnose. Pres de 93 % des patients testeurs souhaiteraient reutiliser le masque d’auto-hypnose lors de leur prochain examen et pres de 96,5 % le conseillerait a leur entourage pour la realisation d’un soin equivalent ( Tableau 1 ). Conclusion L’utilisation de masque sensoriel d’auto-hypnose HYPNOS Pro semble ameliorer la qualite du soin proposee lors de la realisation d’un geste endoscopique en diminuant l’anxiete vecue par le patient lors de cet examen. Ces resultats preliminaires devront etre controles par une evaluation plus approfondie de cet outil, qui pourraient s’integrer dans le cadre de l’amelioration de la bientraitance du patient.

Objectives: The prenatal finding of a large cystic adrenal mass raises the dilemma of the differential diagnosis between adrenal hemorrhage and cystic neuroblastoma. The possibility of a neuroblastoma usually leads to surgical excision of such tumors. Nevertheless, an adrenal hemorrhage has to be recognized, so that unnecessary surgery may be avoided. Methods: Three cases of large prenatally detected adrenal masses managed nonoperatively are reported. Data studied were: age at the diagnosis, prenatal and postnatal ultrasonographic consistency, and tumor marker levels. Size and sonographic evolution were also studied. Results: In all 3 cases, a cystic mass, measuring more than 40 mm in size, was detected during the 3rd trimester of pregnancy. The sonographic appearance evolved from a sonolucent tumor to a heterogeneous mass with hyperechoic areas. The tumor marker levels were normal. All infants had a documented decrease in mass size at birth and were managed nonoperatively. All these tumors were considered adrenal hemorrhages. Conclusions: Prenatal ultrasonography rarely permits to distinguish an adrenal hemorrhage from a cystic neuroblastoma. The differential diagnosis, even in large masses, is based on close postnatal follow-up with serial sonography. Surgery is not mandatory, unless the size does not decrease. However, without pathologic proof, it is not possible to differentiate an adrenal hemorrhage from a spontaneously resolved neuroblastoma.

Resume Depuis la liberalisation legale de la pratique de lˈIVG en 1975, toutes les etudes ont montre une relative stabilite du taux dˈIVG rapporte au nombre dˈaccouchements, alors que les pouvoirs publiques sˈattendaient a voir une nette diminution de ce taux. Par ailleurs depuis 1985 on note une augmentation du nombre des IVG iteratives. Objectifs – Notre travail a ete de comparer sur le plan epidemiologique deux populations de demandeuses dˈIVG dˈun meme centre sur un intervalle de 15 ans. Puis nous avons analyse les donnees psycho-sociales propres aux patientes recourant a des IVG repetees (R). Resultats – Il sˈagit dˈune etude retrospective de 691 patientes, menee au centre dˈorthogenie du CHU de Dijon (principal centre de Cote dˈOr), comparant un echantillon representation dˈune population de demandeuses dˈIVG de 1982 (348) et de 1996 (343). Il y a plus de femmes non mariees ( p = 0,0003), de nullipares ( p = 0,0017) et de nulligestes ( p = 0,03) en 1996. Lˈintervalle de temps entre la precedente grossesse et l'IVG est plus court en 1996 quˈen 1982 ( p = 0,027) et cette gestite est plus souvent une IVG en 1996 ( p = 0,031). Les R (1 IVG ou plus) sont passees de 15,8 % en 1982 a 21,6 % en 1996 avec un taux de femmes ayant deux IVG ou plus (multiR) qui est passe de 1,4 % a 5,2 % ( p = 0,0 13). Les R ont plus dˈenfants que les femmes ayant recours pour la premiere fois a l'IVG (nonR) pour les deux annees ( p = 0,0003) et il y a plus de femmes de moins de 30 ans chez les R en 1996 quˈen 1982 ( p p = 9.10 –5 ) et de la premiere grossesse ( p = 10 –6 ) chez les R est plus bas que chez les nonR pour lˈannee 1996. Il n’y a pas de difference dans les causes dˈechec de contraception, les motifs de la demande dˈIVG et les categories socio-professionnelles entre R et nonR. Conclusions – Globalement si la population des demandeuses dIVG a peu evolue en 15 ans, les R et surtout les multiR representent une population particuliere qui se demarque de la population generale par ses problemes socio-economiques (chomage, RMI), avec instabilite conjugale et ambivalence entre desir de grossesse et non dˈenfant. Il existe par ailleurs une veritable precarite psycho-sociale dont il faudra tenir compte. En effet, cette population est parfaitement avertie des moyens de contraception existant, aussi la prevention devra se situer plus en amont avec au moins une prise en charge psychologique.

To assess the influence of the perineal-to-skull measurement by tranperineal ultrasound (TPU) on the outcome of vaginal operative extraction together with maternal and fetal morbidity.Retrospective, monocentric and descriptive study was done on 272 patients, from 2009 January 1st to 2009 December 31st. It compares the failure rate of instrumental extraction, total caesarean section rate together with the maternal morbidity (type of perineal tears and post-partum hemorrhage rate) and fetal morbidity (5' Apgar score, arterial pH, transfer in neonatal intensive care unit) to the values obtained with TPU.There is a correlation between the perineal-to-skull measurements higher or equal to 50mm at TPU and the instrumental failure rate (50mm 0.8% vs. ≥50mm 11.9%; P0.0001), caesarean (0.9% vs. 33.3%; P0.0001), post-partum haemorrhage (3% vs. 11.9%; P=0.02), et paediatric intervention (16.7% vs. 31%; P=0.03).Perineal-to-skull distance measured with TPU higher or equal to 50mm is at risk of instrumental failure and maternal morbidity. Associated with clinical examination and usual obstetrical risk factors, TPU could be useful to the decision between operative vaginal delivery and prophylactic caesarean section.

Objectifs Determiner la place de l’index PHI dans le diagnostic moderne du cancer de la prostate (CaP) guide par l’IRM. Methodes Il s’agit d’une etude prospective en cours d’inclusion (janvier 2016), multicentrique. Les patients avaient avant la realisation de biopsies ciblees (systeme koelis) un dosage de l’index PHI. Les donnees recueillies etaient l’ âge, les antecedents familiaux de CaP, les antecedents personnels de biopsies, le statut du toucher rectal et un dosage du PSA total/libre. Les donnees quantitatives et qualitatives etaient analysees respectivement par t test de student et de test de Fisher exact ou Chi2. La precision diagnostique de l’index PHI etait definie par l’aire sous la courbe ROC. Plusieurs scenarios ont ete construits afin de determiner la meilleure place de l’index phi. Resultats Quatre-vingt treize patients ont ete inclus, 40 (43 %) avaient eu un premiere biopsie negative. Le taux de biopsies positive etait de 47,3 % (n = 44). Les caracterisitiques de la population sont presentees dans le Tableau 1 . Les patients ayant des biopsies positives avaient un volume prostatique diminue, un index PHI eleve et plus frequement un scoring PiRads IRM > 3 que les patients sains. L’aire sous la courbe de l’index PHI etait de 0,68 (p = 0,002). Le taux de detection biopsique le nombre de biospies evitees, le taux de cancer non diagnostique (total, score de Gleason ≥ 7) de chaque scenario ( Fig. 1 ) sont rapportes dans le Tableau 2 . Conclusion L’index PHI de diminuer le taux de cancer prostatique non detectes par l’IRM tout en evitant environ 50 % de biopsies inutiles. En cas d’IRM peu suspecte (PiRads ≤ 3), l’utilisation de l’index PHI permet de reorienter certains patients vers la realisation de biopsies pour ne pas negliger des cancers de score de Gleason ≥ 7.

Objectifs Le systeme de traitement par HIFU Focal One permet l’utilisation des cartographies biopsiques prostatiques Koelis, avec la realisation en peroperatoire d’une fusion elastique 3D et une echographie realisee durant la phase de traitement. Methodes Le systeme de traitement par HIFU Focal One permet la realisation d’une fusion elastique 3D avec les cartographies Koelis. La fusion necessite la validation de l’ensemble des biopsies Koelis et son exportation sur le systeme Focal One . Une fois l’acquisition echographique realisee, un contourage de la prostate est realise avec la determination de l’apex, de la base prostatique et de trois contours prostatiques. Apres realisation de la fusion Koelis- Focal One , il sera possible de faire apparaitre, au niveau de l’ecran de planification, les contours prostatiques, les differentes biopsies (positives et negatives), ainsi que les zones cibles determinees en IRM. Resultats La fusion de la cartographie Koelis, durant la phase de traitement par HIFU, permet une meilleure localisation des zones tumorales symbolisees par les cibles IRM et la distribution 3D de l’ensemble des biopsies. Cela permettra d’adapter au mieux les marges de traitement notamment au niveau de l’apex ( apex-sparing ) ou au niveau des bandelettes neurovasculaires ( nerve-sparing ). Cette cartographie pourra aussi etre utilisee lors de la realisation de l’echographie de contraste pour controler la qualite du traitement et decider en peroperatoire de l’interet d’un retraitement immediat en cas de sous traitement (biopsies positives ou cibles en dehors de la zone devascularisee). Conclusion La fusion elastique Koelis/ Focal One est une nouvelle option permettant d’ameliorer le guidage du traitement par HIFU Focal One . Son utilisation, lors de la realisation de l’echographie de controle, permettrait de diminuer le risque de sous traitement.

Objectifs L’evolution des recommandations sont marquees par l’extension des indications de la nephrectomie partielle. L’assistance robotique semble permettre une diminution de la courbe d’apprentissage, des durees d’ischemie chaudes, des durees operatoires, des taux de complications perioperatoires et de marges positives comparees a la laparoscopie pure. L’objectif de cette video est de partager notre technique reproductible, alternative au traitement par voie anterieure. Methodes La chirurgie renale robot assistee par voie retroperitoneale a ete effectuee a l’aide du systeme robotise DaVinci Si 3 bras, les pinces utilisees pour le robot etaient : 1 ciseaux, 1 porte-aiguille, 1 pince bipolaire (maryland), trocarts sterilisables, clamps (bulldogs) sterilisables, pas d’utilisation de ballon de dissection. L’indication de chirurgie partielle est decrite avec son iconographique par scanner et l’intervention filmee comporte l’installation du patient, la mise en place des trocarts et le positionnement du robot ainsi que les temps forts de l’intervention et les principales suites operatoires. Resultats Cette video de nephrectomie partielle renale par voie retroperitoneale a permis de preciser d’une part, la position des trocarts et du robot pour eviter les conflits, mais a egalement montre l’apport du robot en terme d’ergonomie, de dissection et de suture dans une zone anatomique restreinte, avec conservation des objectifs oncologiques, fonctionnels (ischemique et comorbidites) et de duree operatoire. Conclusion Cette video met en evidence l’apport du systeme robotique dans la chirurgie partielle du rein par voie retroperitoneale, permettant notamment le gain ergonomique sans alteration des imperatifs oncologiques et fonctionnels. La voie d’abord ne doit pas modifier l’indication chirurgicale et la voie retroperitoneale peut ainsi permettre une plus grande modulation des indications en chirurgie mini-invasive.

International audience; Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder with manifestations mainly involving the skeletal, ocular, and cardiovascular systems. The phenotypic variability observed in MFS makes genetic counselling difficult. Prenatal diagnosis (PND) and preimplantation genetic diagnosis are technically feasible when a causal mutation is identified, but both raise many ethical questions in this condition. Little is known about opinions and practices in such reproductive issues in MFS. The goal of this study was to report on patients' points of view and geneticists' standard practices. Two different questionnaires were produced. Fifty geneticists filled in the questionnaire. Twenty-two per cent thought that PND was acceptable, 72% debatable and 6% not acceptable. Preimplantation genetic diagnosis was more often reported acceptable (34% of answers). Results varied according to the physician's experience with the disease. Fifty-four answers were collected for patients' questionnaires. Most of them (74%) were favourable to the development of prenatal testing, and believed that the choice should be given to parents. However, only a minority would opt for prenatal diagnosis for themselves. This study showed that the majority of patients were in favour of PND and that opinions among practitioners varied widely, but that overall, practitioners favoured a systematic multidisciplinary evaluation of the couple's request.