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Holmes A, Thant A, Correy R, Vilain R. Inflammatory pseudotumour arising secondary to VEXAS syndrome. Pathology 2023; 55:161-163. [PMID: 35843757 DOI: 10.1016/j.pathol.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/26/2022] [Indexed: 01/24/2023]
Affiliation(s)
- Alex Holmes
- Department of Haematology, Calvary Mater Newcastle, Waratah, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
| | - Aung Thant
- Department of Haematology, Calvary Mater Newcastle, Waratah, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Rachael Correy
- Department of Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Department of Anatomical Pathology, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Deng S, Reeders J, Vilain R. Pineal region germinoma – A Case report. Pathology 2021. [DOI: 10.1016/j.pathol.2021.05.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Griffin C, Vilain R, King S, Nixon S, Gooley A, Bray S, Lynam J, Walker MM, Scott RJ, Paul C. Mind Over Matter: Confronting Challenges in Post-Mortem Brain Biobanking for Glioblastoma Multiforme. Biomark Insights 2021; 16:11772719211013359. [PMID: 35173408 PMCID: PMC8842456 DOI: 10.1177/11772719211013359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Over the past 10 years, there has been limited progress for the treatment of brain cancer and outcomes for patients are not much improved. For brain cancer researchers, a major obstacle to biomarker driven research is limited access to brain cancer tissue for research purposes. The Mark Hughes Foundation Brain Biobank is one of the first post-mortem adult brain banks in Australia to operate with protocols specifically developed for brain cancer. Located within the Hunter New England Local Health District and operated by Hunter Cancer Biobank, the boundaries of service provided by the Brain Bank extend well into the surrounding regional and rural areas of the Local Health District and beyond. Brain cancer biobanking is challenging. There are conflicting international guidelines for best practice and unanswered questions relating to scientific, psychosocial and operational practices. To address this challenge, a best practice model was developed, informed by a consensus of existing data but with consideration of the difficulties associated with operating in regional or resource poor settings. The regional application of this model was challenged following the presentation of a donor located in a remote area, 380km away from the biobank. This required biobank staff to overcome numerous obstacles including long distance patient transport, lack of palliative care staff, death in the home and limited rural outreach services. Through the establishment of shared goals, contingency planning and the development of an informal infrastructure, the donation was facilitated within the required timeframe. This experience demonstrates the importance of collaboration and networking to overcome resource insufficiency and geographical challenges in rural cancer research programmes.
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Affiliation(s)
- Cassandra Griffin
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Simon King
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Sandy Nixon
- Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Alisha Gooley
- Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia
| | - Samara Bray
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - James Lynam
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
| | - Rodney J Scott
- Hunter Cancer Biobank
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- NSW Health Pathology, Department of Anatomical Pathology, John Hunter Hospital, Newcastle, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, NSW, Australia
- Hunter Cancer Research Alliance
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, Australia
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Maddison K, Graves M, Bowden N, Vilain R, Fay M, Tooney P. IMMU-51. PROFILING THE IMMUNE SYSTEM IN PRIMARY AND RECURRENT GLIOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Immunotherapy has been shown to have benefit in some solid tumours including melanoma where immune infiltration can be pronounced. Until recently the central nervous system was thought to be immune privileged. Whilst research has shown that immune cells are capable of infiltrating tumours from glioblastoma patients, to date immunotherapy trials have not consistently shown a benefit in these patients. The aim of this study was to profile the immune system in primary and recurrent tumours from glioblastoma patients. Formalin-fixed paraffin-embedded sections of primary and matched recurrent tumours from 13 patients with glioblastoma were processed for immunohistochemical labelling of a range of immune cell markers. Immune infiltration was scored on digitally scanned immunolabelled sections using a categorical system of 0 (absent), 1 (present), 2 (moderate) and 3 (marked). CD3+ cells were observed in three topographical locations within primary and recurrent glioblastoma tumours namely the tumour proper, perivascular spaces and associated with haemorrhages within the tumour. CD3+ cell infiltration into the tumour proper was present (Score = 1) in 7 of 13 primary and recurrent tumours. Only one case (case #9) had CD3+ infiltration scores > 1 for both primary (score = 3) and recurrent tumour (score = 2). CD3+ cells were observed in perivascular spaces in 10 of the 13 cases of primary and recurrent glioblastoma. Only case #9 had CD3+ cells in perivascular spaces that was scored >1 for both primary and recurrent tumours. In conclusion, whilst CD3+ infiltration was observed in the tumour proper and perivascular spaces within both primary and recurrent glioblastomas, the level of infiltration was quite low in this small cohort and as such requires further investigation in a larger cohort.
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Affiliation(s)
- Kelsey Maddison
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Moira Graves
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Nikola Bowden
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Ricardo Vilain
- Pathology North (Hunter), NSW Health Pathology, New Lambton Heoghts, NSW, Australia
| | - Michael Fay
- Genesis Cancer Care, Gateshead, NSW, Australia
| | - Paul Tooney
- The University of Newcastle, Callaghan, New South Wales, Australia
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Van Der Westhuizen A, Graves M, Levy R, Majid A, Vilain R, Bowden N. PRIME002: Early phase II study of azacitidine and carboplatin priming for avelumab in patients with advanced melanoma who are resistant to immunotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz255.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ng R, Eliezer D, Vilain R, Kamien B, Deshpande AV. Fatal Exsanguination Following Rupture of an Iliac Artery Aneurysm in an Infant With Menkes Disease. Pediatr Dev Pathol 2019; 22:486-491. [PMID: 30935272 DOI: 10.1177/1093526619841152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Menkes disease (MD) usually presents in infancy with respiratory and neurological complications. Severe isolated vasculo-connective tissue involvement in infancy is rare, and hence the precise and timely diagnosis is difficult. We report a case of an 8-week-old male infant who succumbed to acute, severe exsanguination, and hemorrhagic shock secondary to a large retroperitoneal hematoma due to rupture of a right iliac artery aneurysm. Perimortem musculoskeletal findings raised suspicion of nonaccidental injury. However, postmortem review of facial traits raised the suspicion of MD. MD was subsequently confirmed on genetic testing. Child health clinicians must remain aware of MD as a rare cause of infant vasculopathy or atypical skeletal abnormalities.
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Affiliation(s)
- Rachel Ng
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
| | - Dilharan Eliezer
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Ricardo Vilain
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Pathology North - Hunter, NSW Health Pathology, Newcastle, Australia
| | - Benjamin Kamien
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Hunter Genetics, Waratah, Australia
| | - Aniruddh V Deshpande
- Department of Paediatric Surgery, John Hunter Children's Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Priority Research Centre GrowUpWell, University of Newcastle, Newcastle, Australia
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Garland J, Tse R, Anne S, Oldmeadow C, Attia J, Vilain R, Elstub H, Kesha K, Stables S, Kuo T, Sunderland M, Garland S, Lam L, Cala A. Use of post mortem vitreous humour electrolytes in diagnosing salt water drowning deaths. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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9
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Holtkamp LHJ, Wang S, Wilmott JS, Madore J, Vilain R, Thompson JF, Nieweg OE, Scolyer RA. Reply to comment on: Detailed Pathological Examination of Completion Node Dissection Specimens and Outcome in Melanoma Patients with Minimal (< 0.1 mm) Sentinel Lymph Node Metastases. Ann Surg Oncol 2017; 24:660. [DOI: 10.1245/s10434-017-6170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 11/18/2022]
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10
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Saletta F, Vilain R, Yuksel A, Gupta A, Nagabushan S, Scolyer R, Daniel C, Byrne J, McCowage G. PD-L1 expression and association with patient outcome in a large pediatric cohort. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Putot A, Rozé B, Pierre-François S, Pircher M, Vilain R, Miossec C, Desbois N, Hochedez P, Abel S, Cabié A. IST-06 - Réémergence de la syphilis chez les personnes infectées par le VIH en Martinique en 2015. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Madore J, Strbenac D, Vilain R, Menzies AM, Yang JYH, Thompson JF, Long GV, Mann GJ, Scolyer RA, Wilmott JS. PD-L1 Negative Status is Associated with Lower Mutation Burden, Differential Expression of Immune-Related Genes, and Worse Survival in Stage III Melanoma. Clin Cancer Res 2016; 22:3915-23. [PMID: 26960397 DOI: 10.1158/1078-0432.ccr-15-1714] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE Understanding why some melanomas test negative for PD-L1 by IHC may have implications for the application of anti-PD-1 therapies in melanoma management. This study sought to determine somatic mutation and gene expression patterns associated with tumor cell PD-L1 expression, or lack thereof, in stage III metastatic melanoma to better define therapeutically relevant patient subgroups. EXPERIMENTAL DESIGN IHC for PD-L1 was assessed in 52 American Joint Committee on Cancer stage III melanoma lymph node specimens and compared with specimen-matched comprehensive clinicopathologic, genomic, and transcriptomic data. RESULTS PD-L1-negative status was associated with lower nonsynonymous mutation (NSM) burden (P = 0.017) and worse melanoma-specific survival [HR = 0.28 (0.12-0.66), P = 0.002] in stage III melanoma. Gene set enrichment analysis identified an immune-related gene expression signature in PD-L1-positive tumors. There was a marked increase in cytotoxic T-cell and macrophage-specific genes in PD-L1-positive melanomas. CD8A(high) gene expression was associated with better melanoma-specific survival [HR = 0.2 (0.05-0.87), P = 0.017] and restricted to PD-L1-positive stage III specimens. NF1 mutations were restricted to PD-L1-positive tumors (P = 0.041). CONCLUSIONS Tumor negative PD-L1 status in stage III melanoma lymph node metastasis is a marker of worse patient survival and is associated with a poor immune response gene signature. Lower NSM levels were associated with PD-L1-negative status suggesting differences in somatic mutation profiles are a determinant of PD-L1-associated antitumor immunity in stage III melanoma. Clin Cancer Res; 22(15); 3915-23. ©2016 AACR.
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Affiliation(s)
- Jason Madore
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dario Strbenac
- School of Mathematics and Statistics, The University of Sydney Camperdown, New South Wales, Australia
| | - Ricardo Vilain
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Jeen Y H Yang
- School of Mathematics and Statistics, The University of Sydney Camperdown, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Centre for Cancer Research, The University of Sydney at Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia. Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
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Beckers RK, Selinger CI, Vilain R, Madore J, Wilmott JS, Harvey K, Holliday A, Cooper CL, Robbins E, Gillett D, Kennedy CW, Gluch L, Carmalt H, Mak C, Warrier S, Gee HE, Chan C, McLean A, Walker E, McNeil CM, Beith JM, Swarbrick A, Scolyer RA, O'Toole SA. Programmed death ligand 1 expression in triple-negative breast cancer is associated with tumour-infiltrating lymphocytes and improved outcome. Histopathology 2016; 69:25-34. [PMID: 26588661 DOI: 10.1111/his.12904] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/14/2015] [Indexed: 01/08/2023]
Abstract
AIMS Triple-negative breast cancer (TNBC) patients generally have a poor outcome; there is a pressing need to identify more effective therapeutic strategies. Clinical trials targeting programmed death 1/programmed death ligand 1 (PD1/PDL1) in melanoma and non-small-cell lung cancer have reported high response rates, and tumoral PDL1 expression has been suggested as a potential biomarker to enrich for patient response to these treatments. There are only very limited data to date reporting the expression of PDL1 in TNBC. METHODS AND RESULTS PDL1 immunohistochemistry was performed on 161 primary TNBCs and assessed in the tumour as well as immune cells in the stromal compartment. PDL1 expression was very common in TNBC, expressed in the tumour cell membrane (64%), cytoplasm (80%) and stromal (93%) cellular compartments. Cytoplasmic tumoral expression of PDL1 was associated with a lower risk of breast cancer-specific death [hazard ratio (HR) 0.45, P = 0.035] while stromal PDL1 expression was associated with a lower rate of deaths from all causes (HR 0.305, P = 0.0042). Membranous expression of PDL1 was not associated with outcome. While both PDL1 expression and tumour-infiltrating lymphocytes were associated with a better outcome, only lymphovascular invasion and high tumour-infiltrating lymphocytes were independently prognostic for breast cancer-specific death. CONCLUSION While PDL1 expression is frequent in TNBC, it was not independently prognostic. There were differences in outcome depending on the cellular compartment of PDL1 expression. These data provide further impetus for investigating the utility of immune checkpoint therapies in TNBC, given the clinical significance of tumour-infiltrating lymphocytes (TILs) and PDL1 expression in this cohort.
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Affiliation(s)
- Rhiannon K Beckers
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christina I Selinger
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ricardo Vilain
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Jason Madore
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - James S Wilmott
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Kate Harvey
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Anne Holliday
- The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Caroline L Cooper
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Robbins
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - David Gillett
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Strathfield Breast Centre, Strathfield, NSW, Australia
| | - Catherine W Kennedy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Strathfield Breast Centre, Strathfield, NSW, Australia
| | - Laurence Gluch
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Strathfield Breast Centre, Strathfield, NSW, Australia.,Department of Breast and Endocrine Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Hugh Carmalt
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Strathfield Breast Centre, Strathfield, NSW, Australia.,Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Cindy Mak
- Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sanjay Warrier
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Breast Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Department of Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Harriet E Gee
- Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Department of Oncology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Charles Chan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Anatomical Pathology Department, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Anna McLean
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Emily Walker
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Catriona M McNeil
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jane M Beith
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Alexander Swarbrick
- The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Darlinghurst, NSW, Australia
| | - Richard A Scolyer
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - Sandra A O'Toole
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,The Kinghorn Cancer Centre and Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Darlinghurst, NSW, Australia
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Holtkamp LHJ, Wang S, Wilmott JS, Madore J, Vilain R, Thompson JF, Nieweg OE, Scolyer RA. Detailed pathological examination of completion node dissection specimens and outcome in melanoma patients with minimal (<0.1 mm) sentinel lymph node metastases. Ann Surg Oncol 2015; 22:2972-7. [PMID: 25990968 DOI: 10.1245/s10434-015-4615-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nonsentinel lymph nodes (NSLNs) are rarely involved in patients with minimal volume melanoma metastases in sentinel lymph nodes (SLNs). Therefore, it has been suggested that completion lymph node dissection (CLND) is not required. However, the lack of routine immunohistochemical staining and multiple sectioning may have led to failure to identify additional positive nodes. The present study sought to more reliably determine the tumor status of NSLNs in patients with minimally involved SLNs and their clinical outcome. METHODS A total of 21 tumor-negative CLND specimens from 20 patients with SLN metastases of <0.1 mm in diameter treated between 1991 and 2013 were examined with a more detailed pathologic protocol (five new sections stained with/for H&E, S-100, HMB45, Melan-A, and H&E). Clinical follow-up data were also obtained. RESULTS Of the 343 examined NSLNs, 1 was found to harbor a 0.18-mm subcapsular sinus metastasis. No metastases were identified in the other NSLNs. Median follow-up was 48 months (range 17-130 months). Six patients (30 %) developed a recurrence. At the end of follow-up, 15 patients (75 %) were alive without sign of melanoma recurrence and 5 patients (25 %) had died of melanoma. Estimated 5-year melanoma-specific survival was 64 %. The patient with the additional positive NSLN remains without recurrence after 130 months follow-up. CONCLUSIONS Although the risk of additional nodal involvement is low, detailed pathologic examination may identify NSLN metastases not identified using routine protocols. Therefore, nodal clearance appears to be the safest option for these patients, pending the results of prospective trials.
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Kakavand H, Wilmott JS, Menzies AM, Vilain R, Haydu LE, Yearley JH, Thompson JF, Kefford RF, Hersey P, Long GV, Scolyer RA. PD-L1 Expression and Tumor-Infiltrating Lymphocytes Define Different Subsets of MAPK Inhibitor-Treated Melanoma Patients. Clin Cancer Res 2015; 21:3140-8. [PMID: 25609064 DOI: 10.1158/1078-0432.ccr-14-2023] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/13/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the expression of tumor PD-L1 and changes in tumor-infiltrating lymphocyte (TIL) populations in patients with metastatic melanoma treated with targeted MAPK inhibitors. EXPERIMENTAL DESIGN Ninety-three tumors were analyzed from 40 patients treated with a BRAF inhibitor alone (BRAFi; n = 28) or combination of BRAF and MEK inhibitors (Combi; n = 12). Tumors were excised before treatment (PRE), early during treatment (EDT), and at progression (PROG). Immunohistochemical staining was performed for CD4, CD8, CD68, FOXP3, LAG3, PD-1, and PD-L1 and correlated with clinical outcome. RESULTS Patients' tumors that were PD-L1 positive at baseline showed a significant decrease in PD-L1 expression at PROG (P = 0.028), whereas patients' tumors that were PD-L1 negative at baseline showed a significant increase in PD-L1 expression at PROG (P = 0.008) irrespective of treatment with BRAFi or Combi. Overall PD-L1 expression highly correlated with TIL immune markers. BRAFi-treated patients showed significant increases in CD4(+), CD8(+), and PD-1(+) lymphocytes from PRE to EDT (P = 0.001, P = 0.001, P = 0.017, respectively), and Combi-treated patients showed similar increases in CD4(+) and CD8(+) lymphocytes from PRE to EDT (P = 0.017, P = 0.021). CONCLUSIONS The addition of MEKi to BRAFi did not result in significant reduction in immune infiltration in EDT biopsies. This provides support for conducting trials that combine MAPKi with immune checkpoint inhibitors in the hope of improving complete and durable response rates. PD-L1 expression at PROG on MAPK inhibitors varied according to baseline expression suggesting that combining MAPKi with immunotherapies concurrently may be more effective in patients with PD-L1 expression and TILs in baseline melanoma samples.
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Affiliation(s)
- Hojabr Kakavand
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | - James S Wilmott
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | - Ricardo Vilain
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lauren E Haydu
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | | | - John F Thompson
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | - Richard F Kefford
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Crown Princess Mary Cancer Centre, Westmead Hospital, New South Wales, Australia. Australian School of Advanced Medicine, Macquarie University, New South Wales, Australia
| | - Peter Hersey
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia. Kolling Institute of Medical Research, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, North Sydney, New South Wales, Australia. Sydney Medical School, the University of Sydney, Sydney, New South Wales, Australia. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Kakavand H, Vilain R, Wilmott JS, Burke H, Yearley J, Thompson JF, Hersey P, Long GV, Scolyer RA. PD-L1 expression, immune cell correlates, and PD-1+ lymphocytes in sentinel lymph node positive melanoma patients: Implications for adjuvant PD-1 clinical trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e20011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ricardo Vilain
- Tissue Pathology and Diagnostic Oncology, Sydney, Australia
| | - James S Wilmott
- Melanoma Institute Australia; Discipline of Pathology, Sydney Medical School, The University of Sydney, Syndey, Australia
| | - Hazel Burke
- Melanoma Institute Australia, North Sydney, Australia
| | | | - John F Thompson
- Melanoma Institute Australia at Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia
| | - Peter Hersey
- University of Newcastle, Newcastle, NSW, Australia
| | - Georgina V. Long
- Melanoma Institute Australia and The University of Sydney, North Sydney, Australia
| | - Richard A Scolyer
- Royal Prince Alfred Hospital/Melanoma Institute Australia/University of Sydney, Sydney, Australia
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Luk PP, Vilain R, Crainic O, McCarthy SW, Thompson JF, Scolyer RA. Punch biopsy of melanoma causing tumour cell implantation: another peril of utilising partial biopsies for melanocytic tumours. Australas J Dermatol 2015; 56:227-31. [PMID: 25827527 DOI: 10.1111/ajd.12333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/20/2015] [Indexed: 02/01/2023]
Abstract
The recommended initial management for suspected melanoma is excisional biopsy. The use of partial biopsies of melanocytic tumours poses potential problems including misdiagnosis due to either unrepresentative sampling or the difficulty in evaluating important diagnostic features; an inaccurate assessment of Breslow thickness and other important prognostic features; and the induction of changes capable of mimicking melanoma (i.e., pseudomelanoma). Misdiagnosis, in turn, may lead to inappropriate management of the patient and an adverse outcome. In this report we document a previously unrecognised pitfall of partial biopsies of melanocytic tumours: implantation of tumour cells at the biopsy site potentially leading to the overestimation of tumour thickness or a misdiagnosis of the presence of microsatellites in the subsequent wide excision specimen.
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Affiliation(s)
- Peter P Luk
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia
| | - Ricardo Vilain
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Oana Crainic
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Stanley W McCarthy
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, Poche Centre, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Vilain R, Wilmott JS, Scolyer RA. A light shines on melanoma metastagenesis. Pigment Cell Melanoma Res 2014; 27:696-7. [PMID: 24890897 DOI: 10.1111/pcmr.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Vilain R, Soyer R. [Surgical treatment of incisional hernias. 1964]. Ann Chir 1998; 51:569-71. [PMID: 9432961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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20
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Vilain R. [Surgical pathology of the big toe. 1965]. Ann Chir 1998; 51:581-2. [PMID: 9432966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Vilain R. [Finger skin defects and their treatment (based on a series of 100 cases). 1954]. Ann Chir 1998; 51:413-20. [PMID: 9432932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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22
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Abstract
The authors analyse a clinical series of 87 operated cases of acute septic arthritis of the fingers. Arthritis followed either a direct neglected punctiform inoculation or an adjacent infection (subcutaneous felon), or a serious open wound having received emergency surgery. During surgery a careful assessment was made of the extent of the infection, indicating the condition of the cartilage and that of the articular and periarticular soft tissues. Treatment was either conservative (surgical drainage, synovectomy and closure) or non-conservative (arthrodesis, articular resection or even amputation). The short term results were evaluated on recovery from infection and the long term results (after six months) on the joint function. There is a correlation between the causative factor, the pathology and the prognosis: direct punctiform inoculations operated upon at an early stage and simple joint wounds did not have a regional infection; in all other cases there was one. Conservative treatment was limited to those patients with no regional infection. In these cases, a localized abnormal aspect of the cartilage did not prove to be irreversible. Thus the prognosis was good only in cases of direct punctiform inoculations operated upon at an early stage. In the other cases, either the conservative treatment failed, or a non-conservative treatment was decided upon immediately. Severe joint infection leads to residual lack of motion, and the destruction of the articular surfaces may induce the surgeon to perform an arthrodesis. In the early stages of arthritis, surgical attempts have been made at controlling the infection and preserving articular motion (1, 2). The few works published on that matter deal with larger limb joints. In this paper we present a series of 87 cases of acute septic arthritis of the fingers.
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Selinger R, Mitz V, Lemerle JP, Vilain R. [A new test for the functional evaluation of the hand and its contribution to the study of toe transfers: the 5 matches test called "Take Five"]. Ann Chir Main Memb Super 1991; 10:124-37. [PMID: 1716124 DOI: 10.1016/s0753-9053(05)80193-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
After studying a series of thumbs reconstructed by 2nd toe transfer, we devised a new dexterity test: the "five matches test" or "Take Five Test" (R.S.). This test consists of the standardised timed and comparative pick-up of 5 identical fine objects (matches), permitting a simple and quick evaluation which objectively quantifies dexterity in fine pinches. The specificity of our test is that it is bilateral and comparative providing a narrow range of normality. In fact, a marked variability of time-scores is found between different individuals of a normal population, making it difficult to determine a "normal dexterity" criterion. But in the same person, there is little variability between two successive experiments or between the dominant and non-dominant hands. Examining a reconstructed hand, we have chosen as the "normal dexterity" criterion the time-score of the contralateral spared hand, timed first. The final score (from 0 to 4 points) is based on the difference between time-scores of the 2 hands (delay tested hand/spared hand). The "Take Five Test" (five matches pick-up test) has largely proven its efficiency in studying a series of thumbs reconstructed by 2nd toe transfer (operated on by V.M.). Fine pinch dexterity is satisfactory in 45% of cases (65% when long digits are spared), scoring at least 2 points (delay less than 4 seconds). The average score is 1.6 pts (range: from 0 to 4). This test could prove the functional value of parameters such as phalangeal mobility and a short delay between injury and reconstruction.
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Affiliation(s)
- R Selinger
- Service de Chirurgie Orthopédique et Réparatrice, Hôpital Boucicaut, Paris
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24
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Lenoble E, Sokolow C, Ebelin M, Rigot J, Dabos N, Lemerle JP, Vilain R. [Results of the primary repair of 28 isolated median nerve injuries in the wrist]. Ann Chir Main 1989; 8:347-51. [PMID: 2688574 DOI: 10.1016/s0753-9053(89)80034-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Based on the study of a homogeneous series of twenty-eight isolated median nerve injuries at the wrist, sutured as an emergency procedure, the authors determined the course and sequelae of this type of nerve lesion with no associated tendon involvement. Repair was associated with epi-perineural suture performed with an operating microscope, immobilisation in slight flexion of the wrist for three weeks and rehabilitation of sensation. 60.7% of patients obtained a good or very good results with better motor recovery than sensory recovery. Nerve contusion, loss of nerve substance with suture under tension and work accidents were factors of poor prognosis.
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Ebelin M, Mitz V, Le Viet D, Dabos N, Berard V, Lenoble E, Lemerle JP, Vilain R. [Dentistry: a profession at high risk for the hands]. Inf Dent 1988; 70:1905-8, 1910. [PMID: 3246426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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26
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Abstract
The authors report 68 cases of bacterial tenosynovitis (BT) that is the largest international series dealing with this pathology since the introduction of antibiotics. Their study stresses the connection between the quality of the final result and the stage at which the condition is treated. The speed at which the tenosynovitis becomes established depends on the mechanism of infection. One can dissociate BT by direct inoculation with violation of the tenosynovial sheath, from the BT by diffusion through an undamaged sheath. The former progress within a few hours to a few days, the latter slowly in a few days to a few weeks, with a slower onset masked by the clinical signs of the initial infection. They propose a new classification which allows the choice of proper surgical therapy taking into account the type of onset of the BT and the intraoperative findings.
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Affiliation(s)
- C Sokolow
- Service d'Orthopédie-Traumatologie et Chirurgie Réparatrice, Hôpital Boucicaut, Paris
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27
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Vilain R. Plastic surgery in a French teaching program. Ann Plast Surg 1986; 17:174-5. [PMID: 3273093 DOI: 10.1097/00000637-198609000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Chachques JC, Mitz V, Zapata R, Moyen EN, Swanson J, Fontaliran F, Vilain R. Risk and consequence of infection at the site of microsurgical repair: an experimental model. Ann Plast Surg 1986; 17:221-7. [PMID: 3273099 DOI: 10.1097/00000637-198609000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The consequences of postoperative infection at the site of microsurgical repair were studied. The experiment used 60 Wistar rats which were divided into 3 groups of 20 each. The femoral artery, vein, and nerve were transected unilaterally and repaired using microsurgical techniques. Staphylococcus aureus was then inoculated into the wound of group 1. Beta-hemolytic Streptococcus was inoculated into the wound of group 2. Group 3 rats served as controls. Clinical, anatomical, bacteriological and histopathological examinations were performed on postoperative days 8 and 30. Wounds in which S. aureus was inoculated demonstrated a significant tendency toward vascular thrombosis with extensive tissue destruction. In the majority of these cases, the necrosis caused by the primary infection engendered an associated, opportunistic infection. Streptococcal inoculations in group 2 demonstrated less severe changes than in group 1. These changes were characterized by injury of the vascular structures themselves with a significant tendency for thickening of the arterial wall, perivascular inflammation, and hematoma formation at the site of the repair. This model allows demonstration of the enzymatic and toxic consequences of bacterial infection in a postoperative site characterized by cellular destruction and interstitial edema surrounding foreign bodies represented by sutures.
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Affiliation(s)
- J C Chachques
- Laboratory of Experimental Microsurgery, Hôpital Boucicaut, Paris, France
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Abstract
Suction lipectomy using a cannula to create multiple tunnels leaves multidirectional subcutaneous scars that, if deep enough, do not modify the appearance of the skin. The postoperative appearance of waves is due to either subcutaneous fat deficiency or to a relative excess of skin. Easy to distinguish clinically, these two kinds of waves may be avoided by a vertical aspiration technique. Fatty defects may be filled with fat obtained from the margins of the defect or from a distant site. The condition of excess skin must be foreseen and the patient warned that a skin resection will be necessary 6 months later.
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Affiliation(s)
- R Vilain
- Hôpital Boucicaut, Paris, France
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Abstract
Aesthetic surgery of the medial thigh is indicated in three instances: excess of skin, localized steatomery, and diffuse obesity after loss of weight. In the first two cases it is possible to limit scarring to the gluteal fold. In obese patients the functional benefits of a combination excision-suction lipectomy outweigh the disadvantages of the scarring over the medial thigh.
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Affiliation(s)
- R Vilain
- Hôpital Boucicaut, Paris, France
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Abstract
The scalaire incisions were indicated in 34 hands with 58 longitudinal palmar contracture which restrict extension and usually result of deep burns. The technique was suggested by the incisions used in Dupuytren's followed by directed cicatrization and wearing dynamic extension splints for 2 months. The functional results are good and fair in 85 percent of cases. The failure usually come from important articular stiffness. The cosmetic result is most often very good especially when comparing with the disadvantage of skin graft pigmentation.
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Vilain R. [Veins and cellulitis]. Phlebologie 1985; 38:653-9. [PMID: 4095152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There is no relation between what French women call "cellulitis" and the venous problems of genetic origin. It may be that cellulitis is the name given to those extra kilos, to mild obesity, to fatty deposits on the thighs and buttocks (sub-trochanteric and crural steatomeries: "jodhpurs"); the point is that cellulitis is apparent, either immediately or on pinching the skin, as an orange-peel pitting. This problem exteriorises the lobular structure of the surface fat. This derives from excessively large lobules, cutaneous relaxation, or excessive pressure on the walls separating the lobules into compartments. Slimming reduces the large areas of deposit at the base of the buttocks. Musculation of the thighs can improve their appearance. More people think they have cellulitis than are really afflicted with it; this is just one of the many deceptions associated with it.
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Chachques JC, Mitz V, Hero M, Arhan P, Gallix P, Fontaliran F, Vilain R. Experimental cardioplasty using the latissimus dorsi muscle flap. J Cardiovasc Surg (Torino) 1985; 26:457-62. [PMID: 4030877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study was undertaken to examine the possibility of using the latissimus dorsi muscular flap, divided in two parts thus covering the surfaces of the heart, and inserting it into the thoracic cavity by means of a segmental resection of the second rib. After cadaver case studies, 15 operations were performed on 5 Beagle dogs. The first group of 5 operations consisted of a latissimus dorsi flap graft over the heart. The second group and third group of operations (3 and 6 months later) consisted of reoperating for muscular and cardiac biopsies and electrical stimulation tests on the heart-muscle complex. The latissimus dorsi flap provided a sizable mass of contractile tissue. The haemodynamic studies showed no compressive or constrictive phenomenon of the muscle on the heart and revealed the preservation of an appropriate cardiac output for short intervals of time (2 hours), through phasic electrostimulation of the flap. The histopathological studies showed conserved muscular structure. The technical feasibility, histological adaptability and electrophysiological properties of this muscular flap makes it appropriate to develop a functional stimulation programme and perhaps adequate for the treatment of dysplasic, ischemic, tumoral and other acquired or congenital myocardial diseases.
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Dardour JC, Vilain R, Castro D. [Evaluation of 10 years of surgical treatment for decubitus ulcer]. Sem Hop 1984; 60:1051-6. [PMID: 6326292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors report a series of 67 patients presenting with 103 decubitus ulcers, treated between 1969 and 1977, and with a follow-up of one year or more. The majority of the patients were paraplegics, other etiologies being present in smaller numbers and raising different problems. They first studied the importance of the pre-and post-operative treatment. This was followed by study of the importance of different surgical techniques for each of the three localizations (sacral, ischial and trochanteric). They demonstrated the absolute need for surgical management, especially with paraplegic patients. Surgery alone allows rapid healing with a high success rate. While it does not, however, preclude any possibility of recurrence (whatever the technique used), it does at least allow the patient to live a normal life. The authors further emphasize the importance of the preoperative treatment, using the nutripump, and the postoperative treatment, using the pulsating air bed (in preference to the water bed). They consider the nutripump to be the most important breakthrough in this field, in recent years. As regards the different localizations, they consider muscle or musculocutaneous flaps to be the treatment of choice for ischial ulcers, but stress the need for wide ischiectomy and the excision of the bursa. In their experience, insufficient excision is a source of failure, even if the flap is good. Similarly, musculocutaneous flaps offer the best solution for trochanteric ulcers, but again, only accompanied by excision of the bursa. Recognition of coxofemoral arthritis is also essential, and no flap will take until this has been remedied. In the case of sacral ulcers, however, they prefer large rotation skin flaps, which allow further advancement in the event of recurrence. The association of two or three ulcers makes surgical management imperative because of the frequently severe undermining of the patient's general state of health. The treatment of two locations in a single stage is always preferable whenever it is feasible.
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Abstract
The full picture of functional ulnar deficiency, following suture or grafting, was studied and analyzed by two of the authors, who followed this series of patients on a long-term basis. The patients were tested using sphygmometric rubber bulbs in other to determine the overall closing force of the hand (making a fist), and the force of the pinch between the thumb and index ("energetic pinch"). Moreover, radionuclide vascular tests were used in order to find an eventual etiology of the "cold" disease, present in 2/3 of these injured hands. The principal functional deficiencies which bothered the patients and which we were able to demonstrate are as follows: deficient adduction of the thumb: the pinch between the thumb and index is diminished by approximately 50%, impairment, in the spreading of fingers, impairment in the overall force of the grasp, ulnar clawing which may embarrass function of the hand one year after the operation in one fourth of the cases. Therefore it appeared logical to propose an adduction plasty at the same time of repair, whether it was a primary suture or a secondary nerve graft. This adduction plasty uses the flexor digitorum sublimis of the ring finger which is rerouted and passed behind the profondus tendons and brought over to the lateral sesamoid bone of the thumb. This transfer is prolonged and tacked to the extensor pollicis longus in order to prevent the hyperflexion of the proximal phalanx of the thumb of which patients hardly ever complain but which denotes the severeness of ulnar nerve injury. An excellent correlation exists between the severeness of the functional deficiency and the importance of Froment's sign. The study of the other residual deficiencies shows that the restoration of the first dorsal interosseus, the reinforcement of the force of the flexores digitorum profundus of the middle and fourth fingers and of the intrinsics does not seem to be justified on an emergency basis. Zancolli's operation, which has been advocated by certain authors as an emergency procedure, does not seem to be necessary at this stage of repair, but remains a very interesting palliative procedure one year after the nerve repair if still judged necessary. Several clinical examples illustrate the value of long-term follow-up of these operated patients.
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Mitz V, Vilain R. [Esthetic lifting of skin grafts]. Ann Chir 1983; 37:649-54. [PMID: 6370085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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37
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Saffar P, Vilain R. [Sprains and dislocations of the fingers]. Rev Prat 1983; 33:423-8. [PMID: 6844836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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38
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Vilain R. [Hospital hygiene: science or derision]. Chirurgie 1983; 109:631-637. [PMID: 6661976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Vilain R. [Families, I love you, or, a good understanding of hygiene]. Rev Infirm 1982; 32:10-1. [PMID: 6926134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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40
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Vilain R. [Microbial diffusion and antibiotherapy]. Phlebologie 1982; 35:825-32. [PMID: 7156192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cleaning leg ulcers depends on tissular and microbial enzymes, the production of which depends on good vascularization. When an aetiological treatment is started, the microbes ensure sufficient cleaning, leading to granulation and epidermization. Antibiotherapy is pointless. Sometimes it can be detrimental, replacing a natural growth with alien strains which cause diffusion. Very exceptionally, a short course of antibiotherapy may be necessary to cope with signs of diffusion, usually signifying a Group A streptococcal infection, with seasonal recrudescence. The Blue Pus Microbe has no special pathological significance. It merely indicates that the case has become chronic.
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Mitz V, Leviet D, Vilain R. [Carpal tunnel syndrome. Cosmetic incision (author's transl)]. Nouv Presse Med 1982; 11:2353-4. [PMID: 7111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The median nerve compressed in the carpal tunnel can be released by an incision in the "line of life", a natural fold along the axis of the third metacarpal bone. By sectioning the carpal tunnel in the palm of the hand, on the cubital side of the median nerve, division of the external branch and of the sensory cutaneous rami of the nerve can be avoided. Hypertrophic scars are prevented. The part of the carpal tunnel situated in the forearm can be freed by a subcutaneous incision if needed, but compression at that level is much less frequent than in the palm of the hand.
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Mitz V, Vilain R. [Retromuscular implantation of mammary prosthesis for reconstruction of the breast: report on 56 cases (author's transl)]. J Chir (Paris) 1982; 119:381-8. [PMID: 7107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Though retromuscular implantation of mammary prosthesis for breast reconstruction presents certain advantages, a retrospective study of the results of 56 such prostheses implanted in 38 patients demonstrated certain complications related to this procedure. These included: ectopy, secondary migration, poor aesthetic appearance during muscle contractions, formation of a hard shell (33 p. cent of cases), and residual mammary asymmetry. However, the advantages related to the retromuscular site of implantation are sufficiently marked for this technique, described in detail, to be employed in certain chosen indications: sequelae to subcutaneous fatty mammectomies ("benign" breast), mammary reconstruction after resection for cancer or radiodermatitis, and perhaps after the use of musculocutaneous flap from the large dorsal muscles ("malignant" breast), and to increase mammary size in cases of agenesis or total aplasia (Poland's syndrome, "unesthetic"" breast).
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Vilain R, Richard JC, Avril JL. [Management of bites]. Rev Infirm Inf 1981:16-8. [PMID: 6910131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Vilain R. [Severe emergencies involving the limbs. Therapeutic problems]. Nouv Presse Med 1981; 10:219-21. [PMID: 7465356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Richard JC, Latouche X, Lemerle JP, Leviet D, Mitz V, Vilain R. [External fixation in emergency treatment of severe open trauma of the hand. An original technique (author's transl)]. Ann Chir 1980; 34:699-701. [PMID: 7447327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Mitz V, Leviet D, Vilain R. [Replantation of seven torn-off thumbs (author's transl)]. Ann Chir 1980; 34:667-73. [PMID: 7447322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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48
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Vilain R. [The treatment of minor burns by the practitioner]. Rev Prat 1980; 30:547-51. [PMID: 7361052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Vilain R. [Skin and subcutaneous tissue in prolonged immobilization: an ongoing prevention]. Rev Prat 1979; 29:3793-9. [PMID: 547405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mitz V, Leviet D, Vilain R. [When should peripheral nerves be grafted? (author's transl)]. Nouv Presse Med 1979; 8:2815-8. [PMID: 388341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the presence of peripheral nerve damage, the only acceptable procedure is suture without tension, carried out under excellent conditions of fascicular approximation. In the case of loss of substance, immediate or secondary suture should never be performed. In the experience of "S.O.S. Main" secondary suture has led to the most disastrous results. Nerve graft, as an emergency, is legitimate in the case or reimplantations, in view of the high degree of technical competence of the teams, and the experience acquired. Deffered nerve graft is envisaged at about the end of the second month:--either in the absence of suture,--or in the absence of recovery. When there is any doubt, further examination at the 4 th or 5 th month ensures that treatment is not delayed too long. At all events, examinations must be repeated every two months in order to study nerve regrowth and to determine the need for possible though difficult reoperation if it stops.
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