Apolipoproteins C-II and C-III inhibit selective uptake of low- and high-density lipoprotein cholesteryl esters in HepG2 cells

Plasma low- and high-density lipoproteins (LDL and HDL) are cleared from the circulation by specific receptors and are either totally degraded or their cholesteryl esters (CE) are selectively delivered to cells by receptors such as the scavenger receptor class B type I (SR-BI). The aim of the present study was to define the effect of apoC-II and apoC-III on the uptake of LDL and HDL by HepG2 cells. Stable transformants were obtained with sense or antisense strategies that secrete 47-294% the normal level of apoC-II or 60-200% that of apoC-III. Different levels of secreted apoC-II or apoC-III had little effect on LDL and HDL protein degradation by HepG2 cells. However, compared to controls, cells under-expressing apoC-II showed a 160% higher capacity to selectively take up HDL-CE, while cells under-expressing apoC-III demonstrated 70 and 160% higher capacity to take up CE from LDL and HDL, respectively. In experiments conducted with exogenously added apoC-II or apoC-III, no significant effect was observed on lipoprotein-protein association/degradation; however, LDL-CE and HDL-CE selective uptake was significantly reduced in a dose-dependent manner. These results indicate that apoC-II and apoC-III inhibit CE-selective uptake.

Frontotemporal dementia, motor neuron disease and tauopathy: clinical and neuropathological study in a family

We report a familial disorder occurring in three patients that presented as frontotemporal dementia (FTD). A neuropathological study was performed in a 58-year-old patient, who developed FTD 2 years prior to the onset of motor neuron disease (MND), and died at age 62. Lesions indicative of associated MND were observed: neuronal loss in the anterior horns of the spinal cord, Bunina bodies, axonal spheroids, degeneration of the pyramidal tracts, and of FTD: decreased neuronal density and laminar microvacuolation of layers II and III in the frontal and temporal cortex. Ubiquitin-only-immunoreactive changes were found in the spinal cord and medulla, but were absent from the temporal and frontal cortex. There were also widespread deposits of various neuronal and glial inclusions containing abnormally phosphorylated tau protein, the Western blotting pattern of which was characterized by two major bands of 64 and 69 kDa. There were no abnormalities of the entire coding sequences of microtubule-associated protein tau (MAPT) and copper-zinc superoxide dismutase (SOD(1)) genes. Our results suggest that FTD associated with MND can be caused by a larger spectrum of neuropathological lesions than commonly accepted.

Spondylodiscite à Enterobacter cloacae par mésusage intraveineux de la buprénorphine haut dosage

INTRODUCTION

We report a case of Enterobacter cloacae spondylodiscitis related to risk practices in intravenous drug addicts (IVDA).

OBSERVATION

The patient, a former heroin addict, was receiving long-term, high-dose buprenorphine maintenance treatment. He had been misusing the treatment, injecting it daily for several months. The clinical course included several uncommon features that are usually found in IVDA patients: subacute infection, apyrexia, and minimal inflammatory syndrome. This infection also led to the discovery of his HIV infection.

DISCUSSION

Any dorsolumbar pain in IVDA patients, including those receiving regular drug maintenance treatment and especially those with HIV infection, should suggest spondylodiscitis, because of these patients' enhanced sensitivity to infection and the frequent bacteremia caused by persistent or transitory relapse involving injection (exchange of material, reuse of needles, syringes, cotton swabs, and risk of contamination through the hands or saliva).

Radiobiological effect of 99mTechnetium-MIBI in human peripheral blood lymphocytes: ex vivo study using micronucleus/FISH assay

99mTc-MIBI is currently used, for cardiac investigations, for parathyroid thyroid imaging and evaluation of various tumours. It has been demonstrated that 99mTc-MIBI is specifically taken up by the human peripheral blood lymphocytes (HPBL), cells which are known to be highly radiosensitive. To evaluate the possible chromosomal damage induced on HPBL by their in vitro exposure to increasing activities of 99mTc-MIBI and also to establish whether HPBL undergo apoptosis or necrosis after in vitro exposure to 99mTc-MIBI. Blood from two healthy donors were irradiated, incubated in vitro with increasing activities of 99mTc-MIBI corresponding to absorbed doses ranging from 1 microGy, 100 microGy, 1 cGy, 10 cGy, 50 cGy to 1 Gy. The cytokinesis block micronucleus (MN) assay was used and the frequency of binucleated cells (BN) with MN (MNBN) was analyzed in cultured HPBL (in either the G0- or G1- and S1-phase of the cell cycle). The fluorescence in situ hybridization (FISH) with pancentromeric probes was also applied to study the MN regarding whole chromosomes or acentric fragments. Apoptosis induction by 0.1 Gy of 99mTc-MIBI in HPBL was quantified using annexin-V test. The frequencies of MNBC were similar in control cultures and in HBPL cultures exposed to 1 microGy, 100 microGy and 1 cGy. However, they were significantly higher (P<0.05 versus controls and lower doses) after one treatment exposure to 0.25 mCi of 99mTc-MIBI (corresponding to 10 cGy) or more but the percentages of MNBN with 10 cGy, 50 cGy and 1 Gy did not differ significantly. The increase of MNBN was more pronounced (P<0.05) for cells irradiated during G1 phase than for those irradiated during G0 or S1. Using FISH, 80-90% of the MN were centromere negative. Although small, the absolute number of MN positive for centromeric signal and presumably containing whole chromosomes increased with doses. There is a statistically significant (P=0.001 and 0.006) increase of both apoptotic cells and necrosis, respectively, as compared to control cells in two times studied (24 and 36 h). Chromosomic damages can thus be demonstrated in HPBL after in vitro exposure of blood to at least 0.25 mCi of 99mTc-MIBI corresponding to one absorbed dose of 10 cGy, and for this dose, apoptosis and necrosis phenomenons were detected.

Localization and regulation of SR-BI in membrane rafts of HepG2 cells

The scavenger receptor class B, type I (SR-BI) mediates cholesteryl esters (CE) selective uptake from low density lipoprotein (LDL) and high-density lipoprotein (HDL) particles. In a number of tissues expressing caveolin, SR-BI is localized in caveolae. We show using detergent-free sucrose gradients that SR-BI is found in membrane rafts devoid of caveolin-1 in the human hepatoma HepG2 cell. Perturbation of the structure of HepG2 cell membrane rafts with cholesterol oxidase or sphingomyelinase decreased LDL-CE association due to selective uptake by 60%, while HDL3-CE selective uptake was increased 2.3-fold by cholesterol oxidase but was not affected by sphingomyelinase. Sequestration of membrane cholesterol with filipin III decreased LDL-CE selective uptake by 25%, while it had no effect on HDL3-CE selective uptake. Extraction of cell membrane cholesterol with beta-cyclodextrin increased LDL- and HDL3-CE selective uptake by 1.6-fold and 3-fold, respectively. We found that CE-selective uptake from both HDL and LDL occurs by a pathway involving retro-endocytosis in HepG2 cells. An analysis of the effect of SR-BI level on the expression of critical lipid sensor and lipid binding proteins was conducted with stable transformants of HepG2 cell overexpressing SR-BI. We found that liver-type fatty acid binding protein expression level is higher in SR-BI-overexpressing cells and that caveolin-1 and sterol response element binding protein-2 levels are reduced. Thus, in this hepatic cell model, SR-BI is associated with membrane rafts devoid of caveolin and its expression affects intracellular lipid binding and lipid sensor proteins. SR-BI-dependent LDL- and HDL-CE selective uptake are affected differently by the integrity of membrane rafts, but both occur by a retroendocytic pathway in HepG2 cells.

Névrite optique rétrobulbaire associée au traitement par infliximab

Infliximab is a chimeric human-murine monoclonal antibody of the IgG1 type with a high affinity and specificity for tumor necrosis factor alpha (TNFalpha). Infliximab was used in Crohn disease, rheumatoid arthritis, spondyloarthropathy, juvenile idiopathic arthritis, Behcet's disease, Wegener's granulomatosis, HLA-B27-associated uveitis and chronic severe refractory uveitis. Reported adverse effects of this treatment were infections, development of antinuclear antibodies and anti double-stranded DNA, lymphomas, and exacerbation of demyelinating disease. We report a case of infliximab-associated optic neuritis with favorable outcome after systemic steroid treatment.

Investigation of the conjectured nucleon deformation at low momentum transfer

We report new precise H(e,e(')p)pi(0) measurements at the Delta(1232) resonance at Q(2)=0.127 (GeV/c)(2) obtained at the MIT-Bates out-of-plane scattering facility which are particularly sensitive to the transverse electric amplitude (E2) of the gamma(*)N-->Delta transition. The new data have been analyzed together with those of earlier measurements to yield precise quadrupole to dipole amplitude ratios: Re(E(3/2)(1+)/M(3/2)(1+))=(-2.3+/-0.3(stat+syst)+/-0.6(model))% and Re(S(3/2)(1+)/M(3/2)(1+))=(-6.1+/-0.2(stat+syst)+/-0.5(model))% for M(3/2)(1+)=(41.4+/-0.3(stat+syst)+/-0.4(model))(10(-3)/m(pi(+))). The derived amplitudes give credence to the conjecture of deformation in hadrons favoring, at low Q2, the dominance of mesonic effects.

Characteristics of patients with rheumatoid arthritis in France: a study of 1109 patients managed by hospital based rheumatologists

OBJECTIVE

To describe the characteristics of rheumatoid arthritis in patients managed by hospital based rheumatologists in France.

METHODS

All public and non-profit private hospitals in France were invited to participate in a cross sectional study. Clinical data on the day of inclusion and health resources used for rheumatoid arthritis over the previous 12 months (treatments, medical devices, physician visits, examinations, hospital admissions, and other health professional care) were recorded.

RESULTS

1109 patients from 75 centres located throughout the country were included (846 female; mean disease duration, 10.6 years; mean age, 56.7 years). Active disease (swollen joint count > or =6, tender joint count > or =6, and two of: morning stiffness > or =45 min, C reactive protein > or =20 mg/l, erythrocyte sedimentation rate >28 mm/h) was observed in 146 patients (13.2%). Mean (SD) DAS(28) was 4.51 (1.55). Severe extra-articular manifestations were reported in 8.4%. ACR functional status was: class I, 19%; class II, 28%; class III, 31%; class IV, 22%. Comorbidity was observed in 44.9% of cases, particularly chronic pulmonary disease and coronary or peripheral vascular disease. Average AIMS2-SF dimension scores were between 4.56 and 6.18, and mean HAQ was 1.32 (0.77). Disease modifying antirheumatic drugs (DMARDs) were prescribed for 82.1% of the patients. During the previous four weeks, one DMARD was used in 62.5%, and two or more in 19.5%. Corticosteroids were prescribed in 72%.

CONCLUSIONS

In a rheumatoid arthritis population managed by hospital based rheumatologists, the disease was active in 13% and severe in more than one third of cases.

The IPSO study: ibuprofen, paracetamol study in osteoarthritis. A randomised comparative clinical study comparing the efficacy and safety of ibuprofen and paracetamol analgesic treatment of osteoarthritis of the knee or hip

OBJECTIVE

To compare the analgesic efficacy of single and multiple doses of ibuprofen with that of paracetamol in patients with knee or hip osteoarthritis (IPSO study).

METHOD

222 patients were randomised in a double blind, multicentre study-156 (70%) had a painful knee joint and 66 (30%) a painful hip joint. The main efficacy criterion was pain intensity assessment after a single dose (ibuprofen 400 mg, paracetamol 1000 mg). Functional disability assessment and patient global assessment were carried out over 14 days.

RESULTS

The sum of the pain intensity difference over 6 hours after the first administration was significantly higher (p = 0.046) in the ibuprofen group than in the paracetamol group. Over 14 days pain intensity decreased from the first day and was significantly lower in the ibuprofen group than in the paracetamol group (p<0.05). The functional disability of the patient was assessed using the WOMAC; the ibuprofen group improved significantly over 2 weeks compared with the paracetamol group for each of the subscales: stiffness (p<0.002), pain (p<0.001), physical function (p<0.002). The drugs were equally safe.

CONCLUSION

The IPSO study shows that for the treatment of osteoarthritic pain, ibuprofen 400 mg at a single and multiple dose (1200 mg/day) for 14 days is more effective than paracetamol, either as a single dose of 1000 mg or a multiple dose (3000 mg/day). Because ibuprofen and paracetamol have similar tolerability, this study indicates that the efficacy/tolerability ratio of ibuprofen is better than that of paracetamol in this indication over 14 days.

Effects of a multidisciplinary weight loss intervention on anaerobic and aerobic aptitudes in severely obese adolescents

OBJECTIVE

To investigate if a multidisciplinary weight loss programme in adolescents suffering severe obesity allows an improvement of anaerobic and aerobic aptitudes.

DESIGN

In all, 55 adolescents (33 girls and 22 boys) suffering from severe obesity were enrolled in an interdisciplinary weight reduction programme lasting 6-12 months. Progressive submaximal physical activity was performed and national dietary allowances for adolescents with low levels of physical activity were provided.

MEASUREMENTS

Total and regional body composition and anaerobic aptitudes (handgrip strength (HGS), vertical jump height (VJH)) and aerobic aptitudes (maximal aerobic power (MAP), maximal oxygen uptake (VO(2max))) were measured before and after weight loss.

RESULTS

The mean reduction of body mass index (BMI) was similar in girls (21.4+/-5.9%) and boys (23.7+/-6.4%). Fat mass (FM) steepest drop was observed in the trunk (-63.2+/-10.1% in boys and -51.5+/-11.4% in girls). The total lean mass (LM) did not vary in both sexes. Right HGS and VJH increased in both sexes (P<0.05), whereas left HGS increased only in boys. MAP and VO(2max) per kg BW increased (P< 0.0001) in both sexes (2.3+/-0.3 vs 1.7+/-0.3 W/kg and 32.8+/-4.5 vs 26.7+/-4.1 ml/min/kg in girls and 2.8+/-1.9 vs 1.9+/-0.4 W/kg and 39.1+/-6.3 vs 27.9+/-5.1 ml/min/kg in boys, respectively), whereas MAP and VO(2max) in absolute value and per kg LM increased only in boys (P=0.04). Total LM was the strongest determinant of HGS, VJH, MAP and VO(2max) in both sexes (P<0.005).

CONCLUSIONS

Multidisciplinary weight reduction programme including moderate dietary restriction in combination with regular physical training induced an improvement of anaerobic and aerobic aptitudes, a marked reduction of obesity and a preservation of LM in severely obese adolescents.

Contralateral internal mammary node invasion in breast cancer: lymphoscintigraphic data

Contralateral internal mammary (IM) node invasion has been analyzed in 1025 patients where the two IM chains have been investigated by lymphoscintigraphy. Contralateral IM lymphoscintigrams (LySc) were classified as abnormal (nodes involved by metastatic cancer) in 153 cases (or 15.6% of the population) and this included one-third of the cases with homolateral IMLySc abnormalities (114/318). Overall, patients with bilateral abnormalities on IMLySc (Grp A) had a similar survival to those with homolateral abnormal IMLySc (Grp B). However, when other prognostic variables were taken into account and two matched groups were obtained, patients with bilateral internal mammary node involvement had a highest incidence of clinically evident systemic metastatic disease than patients with homolateral IM involvement. Contralateral IM nodes are invaded in one-third of the cases with homolateral IM node invasion. These patients may have a prognosis worse than those with only homolateral IM disease.

Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents

OBJECTIVE

To investigate if a multidisciplinary weight loss program in adolescents suffering severe obesity allows adequate growth and development and avoid lean mass loss.

DESIGN

A total of 55 adolescents (33 girls and 22 boys) suffering severe obesity were enrolled in an interdisciplinary weight reduction program lasting 6-12 months. Progressive submaximal physical activity was performed and national dietary allowances for adolescents with low levels of physical activity energy were provided.

MEASUREMENTS

Total and segmental body composition was assessed by means of dual-energy X-ray absorptiometry.

RESULTS

The mean height significantly increased (P<0.001). The mean body mass index (BMI) dropped in boys from 34.5+/-3.2 to 25.5+/-2.3 kg/m(2) and in girls from 38.4+/-4.1 to 28.4+/-4.1 kg/m(2). Height increased according to the expected pattern (P<0.001). Total lean mass (LM) did not vary and was positively correlated to pubertal development in both sexes before and after weight loss. Steepest drop in fat mass (FM) was observed in the trunk (-63.2+/-10.1% in boys and -51.5+/-11.4% in girls). Decrease in BMI and FM was tightly correlated in both sexes. However, slopes significantly differed (P<0.0005) so that a decrease of 1 kg/m(2) in BMI corresponded to a decrease of 3.92 kg in FM in girls and of 5.44 kg in boys. In each sex, FM at baseline and duration of the treatment were the main determinants of the decrease in FM.

CONCLUSION

During adolescence, despite a major weight loss, adequate growth and preservation of LM can be achieved. Weight loss kinetics markedly differs between boys and girls. Low-calorie diets are unnecessary to achieve a marked reduction of severe obesity during puberty.

Laterally elevated wedged insoles in the treatment of medial knee osteoarthritis. A two-year prospective randomized controlled study

OBJECTIVE

To compare the clinical effects of laterally wedged insoles and neutrally wedged insoles (used as control) in patients with medial femoro-tibial knee osteoarthritis.

STUDY DESIGN

24-month prospective randomized controlled study.

PATIENTS

Outpatients with painful medial femoro-tibial knee osteoarthritis.

OUTCOME MEASURES

Patient's overall assessment of disease activity (5 grade scale), WOMAC index subscales and concomitant treatments.

STATISTICAL ANALYSIS

Performed as an intention-to-treat analysis, with the last observation carried forward (LOCF). Main symptomatic criterion: Improvement in the patient's assessment of activity (defined as a reduction of one grade or more at the end of the study as compared to baseline, and no intra-articular injection or lavage during the 6 months previous to the last visit). Secondary criteria for assessment: (a) Changes in the WOMAC subscales at month 24, and (b) concomitant therapies (analgesics, NSAIDs and intra-articular injections or lavages). Structural criterion: Joint space width (JSW) at the narrowest point. Non-compliance was defined as intermittent or lack of insole fitting at two consecutive visits. Compliance within groups was compared by using a life table analysis technique (Log-Rank).

RESULTS

The baseline characteristics of the 156 recruited patients (41 males, 115 females, mean age 64.8 years) were not different in the 2 treatment groups. At year 2, there was no statistically significant difference between the 2 groups concerning the percentages of patients with improvement in both global assessment of disease activity and in WOMAC subscales (pain, stiffness, function). The number of days with NSAIDs intake was lower in the group with laterally wedged insoles than in the neutrally wedged group (71+/-173 days vs. 127+/-193 days, P=0.003, Mann-Whitney test). The mean joint space narrowing rate did not differ between the two groups: 0.21+/-0.59 mm/year in the laterally wedged group vs 0.12+/-0.32 mm/year in the neutrally wedged group. Compliance and tolerance were satisfactory. Compliance was different between the 2 groups at month 24, with a greater frequency of patients who wore insoles permanently in the laterally wedged insole group than in the other group (85.8% vs 71.9%, P=0.023).

CONCLUSION

This study failed to demonstrate a relevant symptomatic and/or structural effect of laterally-wedged insoles in medial femoro-tibial OA. However, the reduced NSAIDs intake and the better compliance in the treatment group are in favor of a beneficial effect of laterally-wedged insoles in medial femoro-tibial OA.

Sentinel lymph node imaging and research after bone scintigraphy in breast cancer patients

The aim of the study is to see if Bone Scan (BS) - when performed the day before the operation-interferes with the results of the Sentinel Lymph Node (SLN) technique using radiocolloids (their pre-operative imaging and their peroperative research). Therefore, the data of 393 patients who had one selective lymphadenectomy of the SLN(s) followed by the complete axillary node (AxN) clearance for Breast Cancer and among whom 309 patients had one BS the day before the operation (and just before the injection-s for the SLN) and 84 did not, were analysed and compared. The two series presented the same characteristics with regard to: age, clinical staging of the tumour, kind of injection-s performed (intradermic and paratumoural and/or intraparenchymal and peritumoral), pathological size of the tumour, percentage of cases with no AxN invasion, total number of AxN removed by the surgeons. The percentages of no axillary SLN visualisation, the mean numbers of axillary SLN visualised on pre-operative lymphoscintigram as well as of SLN removed by the surgeons were not statistically different in the groups of patients with (respectively, 12.11, 2.6 and 3.03) and without BS (respectively, 12.99, 2.7 and 2.96). More noteworthy, the false negative (FN) rate of the SLN technique, albeit having a higher observed value in the group with BS (9.6%, 12/125), did not differ significantly from that in the group without BS (5.6%, 2/36). The accuracies (overall correct classification rates), the sensitivities and the negative predictive values of the SLN technique also did not differ significantly between the two groups. It is concluded that the SLN technique can be accurately performed just after one BS.

Use of erythropoietin for bloodless surgery in a Jehovah's witness infant

We present a case of surgery in a 2-month-old infant of the Jehovah's Witness (JW) faith weighing 2.8 kg scheduled for left upper lobectomy because of congenital lobar emphysema. He presented with physiological anaemia (haematocrit 33.8%) in accordance with his age. Because of the relative emergency of surgery, a short erythropoietin course was instituted. Recombinant human erythropoietin (rHuEPO) at a dosage of 180 U x kg-1x day-1 was administered for 10 days preoperatively and for 4 days postoperatively. Iron was administered orally and intravenously over the entire perioperative period. No side-effects from either erythropoietin or intravenously administered iron were observed. To our knowledge, this is the first case published of a short perioperative rHuEPO course in an infant.

Epidural corticosteroid injections for sciatica: a randomised, double blind, controlled clinical trial

OBJECTIVE

To determine the efficacy of epidural corticosteroid injections for sciatica.

METHODS

Three epidural injections (two day intervals) of 2 ml prednisolone acetate (50 mg) or 2 ml isotonic saline were administered to patients with sciatica presumably due to a disk herniation lasting 15-180 days. Self evaluation was the main judgment criterion at day 20. Patients who recovered or showed marked improvement were considered as success. Pain measured by VAS, the SLR test, Schober's test, Dallas pain questionnaire, and the Roland-Morris index were evaluated at days 0, 5, 20, and 35. Only analgesics were authorised, patients requiring non-steroidal anti-inflammatory drugs (NSAIDs) before day 20 were considered as failure.

RESULTS

42 patients were included in the control group (CG), 43 in the steroid group (SG). On an intention to treat analysis 15/42 (36%) in the CG and 22/43 (51%) in the SG (p=0.15) were considered as success (difference 15.5%, 95% CI (-5.4 to 36.3)). Among the 48 failures, 14 patients (6 CG, 8 SG) required NSAIDs, 3 (2 CG, 1 SG) required surgery, and 7 (3 CG, 4 SG) other treatments. On analysis according to protocol, in 74 remaining patients 12/35 (34%) in the CG and 22/39 (56%) in the SG (p=0.057) were considered as success (difference 22.1%, 95% CI (0.0 to 44.2)). For all secondary end points intragroup improvement with time was significant, but intergroup differences were not.

CONCLUSION

The efficacy of isotonic saline administered epidurally for sciatica cannot be excluded, but epidural steroid injections provide no additional improvement.

How 'hot' is the pathologically positive sentinel lymph node in breast cancer patients?

When many lymph nodes are found by using lymphoscintigraphic techniques performed to detect the sentinel lymph nodes (SLNs) in breast cancer, it is usual to find that the 'hottest' SLN is not always the node that is pathologically positive (pN+). Various criteria have been proposed to define which radioactive lymph nodes should be removed. In order to determine the frequency with which the hottest SLN 'fails' to be pN+, and to determine which criteria best define the radioactive lymph node to be removed, we reviewed and analysed our cases in which more than one SLN was detected and where there was also at least one pN+ node. From a series of 181 patients, 40 were selected. In 11 of these 40 cases (27.5%), the hottest SLN was not pN+. Radioactivity levels in the pN+SLN of these 11 patients ranged from 2% to 94% of the activity of the hottest SLN. Twenty-one patients (52.5%) showed only micrometastatic (pN1a) disease in one or more SLNs. In four of these patients (19%) the pN1a SLN was not the hottest node. Two of the patients had radioactivity levels in the pN+SLN which were more than 50% of that of the hottest SLN. In another two of these patients (9.5%), radioactivity levels were lower than 50% of that of the hottest node (respectively, 38% and 2%). However, in these two last cases, the first and hottest SLN removed surgically was found, by the pathologist, to consist of six nodes. Macrometastases (dimensions greater than 2 mm) were found in 19 patients. In 12 of these patients, the hottest SLN was macrometastatic although macrometastases and/or micrometastases were found in other 'cooler' SLNs in four of them. In another seven of these patients (36.8%), macrometastases were found in SLNs with radioactive levels lower than 51% of that of the hottest node. One patient (with three SLNs) out of the 40 (2.5%) had one SLN pN+ with less than 10% of that of the hottest. In fact, it contained only one micrometastasis and its activity was equal to 2%. Upon pathological examination, however, the hottest lymph 'node' was found to consist of six nodes. It is concluded that, with four intra-mammary and peritumoural injections of 99mTc labelled nanosized colloids of Human Serum Albumin (Nanocoll R: Sorin: 74 MBq and 0.05 mg per injection) performed 18-24 h before using a gamma probe to detect the SLNs, the hottest SLN was not the pathologically positive node in 27.5% of patients in our series. By using the activity in the hottest SLN as the reference point, and 10% of this activity as the lower threshold for removing active SLNs, the sensitivity of the technique is 97.5%.

[Lower limb edema and steatorrhea: value of scintigraphic technics]

The authors report the case of a young woman with right lower limb edema who also presented one steatorrhea. Her clinical history is typical for one primary lymphedema and the lymphoscintigraphic investigation of the lower limbs confirms the diagnosis. The scan showed the absence of the right iliac and lomboaortic lymph nodes but also that the thoracic duct was normally present. One C14-triolein breath test is pathological and proves the malabsorption of the fats. The authors discuss the interest of the scintigraphic techniques in such case and review the problem of the association between lower limb lymphedemas and fatty malabsorption.

[Limb edema and lymphoscintigraphy]

Lymphoscintigraphic investigations represent techniques of nuclear medicine very contributive for the management and treatment of the limb edemas, either primary or secundary. Their principle is presented and methodologies proposed in the literature are reviewed. Their diagnostic contributions are detailed. The sensitivities and specificities of several protocols of investigation are reported. Some limitations of these examinations are analyzed and discussed. Clinical indications for their use are proposed and their interest with regard to the various treatments that can be applied to these limb edemas is discussed.

[Frontal sinus osteomas: neuro-ophthalmological complications]

Osteomas are the most frequent benign tumors of the paranasal sinuses. They often grow in the frontal sinus near the nasofrontal duct. They remain frequently asymptomatic and they tend to be an incidental finding on radiographic studies. Rarely, they extend out of the sinus limits. Two cases with neuro-ophthalmological complications are reported and discussed. A 19-year-old female presented with a progressive left visual impairment and orbital bone deformity. A CT-scan revealed a large calcified mass in both frontal sinuses, with left intraorbital and frontobasal extension. A 21-year-old man suffered from acute frontoethmoidal sinusitis. Radiological exams revealed a right frontal sinus osteoma with bilateral nasofrontal ducts obstruction. The frontal sinus cavities were filled with a large mucocele with intracranial extension. Both patients were successfully treated using frontobasal craniotomy with complete osteoma and mucocele removal and cranio facial bone reconstruction. Neuro-ophthalmological or intrasinusal complications of osteomas lead to radical treatment. CT-scan and MRI analysis for surgical purpose and strategy are emphased.

Effects of age and lateralization on lymphoscintigraphic interpretation

The present study was undertaken to find out if ageing and lateralization might influence the results of lymphoscintigraphic investigations. Axillary lymphoscintigrams obtained in 756 women after subcutaneous intercostal (IC) injection of 99mTc-labelled colloids at the level of the chest wall were reviewed and analysed according to age (<41 years, 41-50 years, 51-60 years, 61-70 years, 71-80 years, >80 years) and the side injected (right or left). No axillary nodes were visualized (IC-) in 34% of the population, and IC- cases were somewhat, but not significantly (0.10<P<0.05) more frequent after injections in the left side (37%) than after injections in the right side (31%). The frequency of IC - cases increased with age (<41 years, 26%; 41-50 years, 29%; 51-60 years, 36%; 61-70 years, 39%; 71-80 years, 40%; >80 years, four out of seven), and the absence of drainage was more common in patients over 50 years old (overall, 38.2%; right, 36%; left, 40.2%) than in younger cases (overall, 27.9%; right, 24.1%; left, 30.3%). From a statistical point of view, the differences between these two age-discriminated populations were significant both when considering the series of injections as a whole (0.01>2P>0.001) and injections in the right side only (0.01<2P<0.02). In conclusion, ageing and lateralization influence lymphoscintigraphic investigations and have to be taken into account when analysing results.