[Carcinogenesis of the ethmoidal adenocarcinoma due to wood dust]

OBJECTIVES

To recognize the mechanisms and the different oncogenic pathways of ethmoid adenocarcinoma (EADC) in woodworkers.

METHODS

A systematic review of the literature and evaluation according to scientific evidences.

RESULTS

Wood dust less than 10 microm settles on the external aspects of the ethmoid sinus that is the middle turbinate, the middle meatus and the olfactory cleft. The risk of developing an EADC is important from the first year. It is impossible to know what determines the latency period. Usually, this period exceeds 30 years and only 10% of patients are younger than 50 years of age. Chromosomal instability of the respiratory mucosa appears to be one of the major phases in the oncogenic process. Certain biomolecular and genetic factors are shared with the adenocarcinoma of the colon but they are not activated with the same importance and in the same context suggesting two distinct mechanisms of evolution. The local anatomo-clinical setting in the nasal cavity and carcinogenic substances in the wood dust play a key specific role in the development of EADC. No oncoproteins or immunohistochemistry features were identified in the process suggesting a cascade of genetic or molecular series of events.

A copper(II)-selective chelator ameliorates diabetes-evoked renal fibrosis and albuminuria, and suppresses pathogenic TGF-beta activation in the kidneys of rats used as a model of diabetes

AIMS/HYPOTHESIS

The selective Cu(II) chelator triethylenetetramine (TETA) extracts systemic Cu(II) into the urine of diabetic humans and rats as a model of diabetes, and in the process also normalises hallmarks of diabetic heart disease. However, the role of Cu and its response to TETA in animals with diabetic nephropathy were previously unknown. Here, we report the effects of TETA treatment on Cu and other essential elements, as well as on indices of renal injury and known pathogenic molecular processes, in kidneys from a rat model of diabetes.

METHODS

Rats at 8 weeks after streptozotocin-induction of diabetes were treated with oral TETA (34 mg/day in drinking water) for a further 8 weeks and then compared with untreated diabetic control animals.

RESULTS

Renal tissue Cu was substantively elevated by diabetes and normalised by TETA, which also suppressed whole-kidney and glomerular hypertrophy without lowering blood glucose. The urinary albumin: creatinine ratio was significantly elevated in the rat model of diabetes but lowered by TETA. Total collagen was also elevated in diabetic kidneys and significantly improved by TETA. Furthermore, renal cortex levels of TGF-beta1, MAD homologue (SMAD) 4, phosphorylated SMAD2, fibronectin-1, collagen-III, collagen-IV, plasminogen activator inhibitor-1 and semicarbazide-sensitive amine oxidase all tended to be elevated in diabetes and normalised by TETA.

CONCLUSIONS/INTERPRETATION

Dysregulation of renal Cu homeostasis may be a key event eliciting development of diabetic nephropathy. Selective Cu(II) chelation can protect against pathogenic mechanisms that lead to or cause diabetic nephropathy and might be clinically useful in the treatment of early-stage diabetic kidney disease.

Identifying autism loci and genes by tracing recent shared ancestry

To find inherited causes of autism-spectrum disorders, we studied families in which parents share ancestors, enhancing the role of inherited factors. We mapped several loci, some containing large, inherited, homozygous deletions that are likely mutations. The largest deletions implicated genes, including PCDH10 (protocadherin 10) and DIA1 (deleted in autism1, or c3orf58), whose level of expression changes in response to neuronal activity, a marker of genes involved in synaptic changes that underlie learning. A subset of genes, including NHE9 (Na+/H+ exchanger 9), showed additional potential mutations in patients with unrelated parents. Our findings highlight the utility of "homozygosity mapping" in heterogeneous disorders like autism but also suggest that defective regulation of gene expression after neural activity may be a mechanism common to seemingly diverse autism mutations.

Utilisation du lambeau myomuqueux pédiculé par l’artère faciale dans les reconstructions palatines

The facial artery musculomucosal flap (FAMM) is usually used in reconstruction of defects in oral cavity, most frequent being the mouth floor. This flap has many advantages from its surgical procedure, its great reliability, its mucous tissue origin, its usable surface, its large axis of rotation and the little of after-effects of the donor site. The hard palate defects with bucconasal communication can raise difficulties of reconstruction. We show, by a case report, the many advantages of FAMM flap in these reconstructions.

Early cleavage: an additional predictor of high implantation rate following elective single embryo transfer

The value of early cleavage (EC) assessment is still being debated. The aim of this prospective study was to examine the predictive value of EC assessment performed exactly 26 h after insemination by IVF or intracytoplasmic sperm injection (ICSI) in a programme of elective single embryo transfer (SET) performed at day 2. If day 2 scoring demonstrated several embryos with high implantation potential, an EC embryo was transferred preferentially. EC was assessed only during normal laboratory hours so that there were two groups: EC assessed, and EC not assessed, the latter being the control. A total of 277 elective SET were performed in women under 37 years undergoing their first IVF or ICSI cycle (mean age 30.5 years, range 21-37). The overall clinical and ongoing pregnancy rates were 40.1% (111/277) and 32.9% (91/277) respectively. Significantly higher overall clinical and ongoing pregnancy rates were obtained after transfer of an EC embryo than a non-EC embryo: 49.4 versus 33.3% (P < 0.05) and 42.4 versus 25.9% (P < 0.02) respectively. However there was no significant difference between the EC assessed and control groups: 40.4 versus 39.3% and 33.2 versus 32.1 respectively. These findings confirm the value of EC assessment for selection of embryos with high implantation potential.

Fractures of the atlas: can we rely on the NICE guidelines for imaging the cervical spine after head injury?

We describe a patient who was not thought to fulfil the NICE criteria for imaging the cervical spine after head injury but who had two fractures of the atlas, thus rendering the vertebral ring unstable. The reasons for missing this injury in the emergency department are discussed.

Transfert électif d'un seul embryon : une option justifiée pour une population de patientes sélectionnées

OBJECTIVE

Prevention of twin pregnancies using elective Single Embryo Transfer (e-SET) is now considered by many Assisted Reproductive Techniques teams as a necessity. The aim of this study was to assess the efficacy of e-SET in a prospective manner in a selective population of patients using Take Home Baby Rate per couple as principal parameter.

PATIENTS AND METHODS

This prospective study was conducted from January 2003 to December 2004. Elective Single Embryo was proposed to women above 37 years in their first IVF or ICSI attempt. It was then performed only in cases when at least one embryo with high implantation potential (score-4 embryo in our embryo scoring) was obtained for transfer and one more (score-3 or score-4 embryo) was available for freezing.

RESULTS

e-SET was proposed and accepted in 225 couples (25% of eligible couples and 7.8% of total population) and was possible in 96 of these). Two embryos were transferred in all other eligible patients (Double Embryo Transfer group=DET). Cumulative delivery rate after fresh embryo transfers and, if necessary, after frozen-thawed embryo transfers were 39.5% per couple e-SET group and 41.7% in DET group (NS). On the other hand, the percentage of twin pregnancies was significantly different between the two groups (2.6% vs 26.6% respectively; P<0.01).

DISCUSSION AND CONCLUSION

In women younger than 37 years in their first IVF/ICSI attempt, the elective transfer of only one embryo with high implantation potential strongly allowed to avoid twin pregnancies without any significant delivery rate decrease. This transfer policy is particularly efficient in laboratories displaying good results in their embryo freezing program.

[Infectious and non infectious factors in otitis media and in sinusitis]

Les infections de la sphère ORL sont fréquentes et les otites chez l’enfant, les sinusites de l’adulte sont généralement perçues comme étant d’origine bactérienne ou virale. Cependant de nombreux facteurs non infectieux jouent un rôle non négligeable, mais restent souvent méconnus et d’interprétation difficile : ils conduisent encore trop souvent à des thérapeutiques antibiotiques inutiles. Ainsi dans l’otite, ont été reconnus divers facteurs de risque non infectieux tels que : atteinte mécanique de la trompe d’Eustache, immaturité immunitaire, tabagisme passif, carence martiale etc… susceptibles de favoriser l’infection de l’oreille moyenne, souvent virale dans un 1^er temps, secondairement surinfectée par les espèces bactériennes du rhinopharynx ((pneumocoques, Haemophilus influenzae, Moraxella catarrhalis). Les sinusites sont d’étiologie multifactorielle et, si les mécanismes et les agents des sinusites infectieuses (virus et bactéries) sont bien connus, en revanche de multiples facteurs non infectieux peuvent être identifiés : l’allergie est un facteur fréquent qui favorise les sinusites à répétition ; moins souvent reconnus sont le diabète, le reflux gastro-oesophagien, des facteurs anatomiques, des anomalies de la fonction muco-ciliaire ou l’immunodépression dans le cadre VIH. Des recherches doivent être poursuivies pour approfondir ces mécanismes complexes.

[Is coincidence detection emission tomography (CDET) as reliable as positron emission tomography (PET) in head and neck cancer?]

OBJECTIVE

Positron emission tomography (PET) is becoming more and more useful in head and neck tumour detection, guiding diagnostic and therapeutic decision. However, techniques, similar to PET, but using modified conventional tomography equipment, are used. The most commonly used is the dual-head positron emission tomography using coincidence detection (CDET). This study was aimed at searching if CDET could be as reliable as PET in some of its indications.

PATIENTS AND METHODS

Between 1997 and 2001, 19 patients, with head and neck cancer, had a CDET, for 3 indications. We studied retrospectively sensitivity (Se) and specificity (Sp) rates for these 3 indications.

RESULTS

1 degree) Detection of unknown primary head and neck cancers with lymph node manifestation: Se = 100%, Sp = 66,7%. 2 degrees) Detection of body metastasis: Se = 50%, Sp = 33%. 3 degrees) Detection of local recurrent cancer: Se = 100%, Sp = 25%.

CONCLUSION

CDET seems to be useful in finding unknown primary cancers with lymph node manifestation but is not reliable to look for metastasis and local recurrences. It cannot be used in all indications for PET. If no other tool is available, this investigation can be used, keeping in mind its limitations.

[Aspergillosis of the paranasal sinus and environmental factors]

Paranasal sinus aspergilloma is a non-invasive form of Aspergillus infection being encountered more often during the last decade.

METHODS

A survey of specialists in France was carried out in 1998 to investigate the role of environment in the pathogenesis of the disease.

RESULTS

A total of 402 patients' reports were reviewed, most of which involved unilaterally the maxillary sinus. We observed a predominance of women (sex ratio 1.9) and dental care in the past of 338/402 patients (84.1%). Environmental exposure that could interfere with aspergilloma were found in only 136 patients (33.8%) and in 21/48 (43.8%) patients who had had no dental care.

CONCLUSION

Aspergilloma of the paranasal sinus has probably a multifactorial etiology, we could not point out environmental factors in this survey.

Prognostic value of mandibular involvement in oral cavity cancers

OBJECTIVES

The aim of the study was to determine, in a homogeneous population, the prognostic impact of mandibular involvement in oral cancers.

STUDY DESIGN

Retrospective study of 117 patients with T4 squamous cell carcinoma of the oral cavity treated by surgery and radiotherapy in the ENT Department of Bichat-Claude Bernard Hospital. All patients had histologically confirmed mandibular involvement. Patients with partial involvement of the mandible underwent rim mandibulectomy (RM) and those with extensive invasion underwent segmental mandibulectomy (SM).

METHODS

The local failure rate and the overall survival curves were calculated with respect to type of mandibulectomy. The causes of death were analysed.

RESULTS

The surgery was conservative in 55 cases (47%) and segmental in 62 patients (53%). The degree of mandibular involvement did not influence the local failure rate (29% and 25% in the RM and SM groups, respectively). On the other hand, it strongly influenced vital outcome, as five-year survival was only 25.4% after segmental mandibulectomy, compared to 40% after rim mandibulectomy. The metastases and the second primary tumors were more frequent in the SM group.

CONCLUSION

The degree of mandibular invasion influenced the survival rate of patients with squamous cell carcinoma of the oral cavity but this difference is not due to local failure.

[Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors]

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.