Le cancer différencié de la thyroïde chez les patients de moins de 20 ans : à propos de 20 cas

Papillary thyroid cancer is rare in patients under 20 years and has a good prognosis, although it is often found at the stage of lung metastases. Our multicenter study included 20 patients aged between 5 and 18 years, female predominance, followed for differentiated thyroid cancer with lung metastases. All these patients underwent a whole body scan with I-131, serum thyroglobulin, chest radiography in 4 cases and cervico-thoracic (CT) in 5 cases. Only scintigraphic imaging has shown miliary pulmonary among all patients. The therapeutic efficacy was observed in all patients after treatment with iodine-131, which proves the high sensitivity of these metastases to irathérapie. The differentiated thyroid cancer in child and adolescent is characterized by local aggressiveness and a higher frequency of distant metastases than in the adult. Prognosis does not seem to be influenced by histology alone, but by its association with other prognostic factors: age, metastases and surgery.     

La TEP-TDM à la F-Dopa aurait-elle un rôle dans le suivi postopératoire des patients atteints de carcinome médullaire de la thyroïde ? Résultats préliminaires de l’expérience strasbourgeoise et revue de la littérature

Aim

Retrospective study to assess the value of fluorine-18 dihydroxyphenylalanine (¹⁸F-Dopa) positron emission tomography (PET)/computed tomography (CT) in the post-surgical follow-up of patients with history of medullary thyroid carcinoma (MTC) and biological suspicion of disease relapse. A review of the literature was also performed.

Patients and methods

Ten patients (23-71 years) with MTC previously treated by surgery were examined by at least one ¹⁸F-Dopa PET/CT. All patients presented with elevated serum calcitonin (130-9076 ng/l) and/or CEA (1.2-518 ng/ml) levels. 3D whole body PET/CT was performed 45 and 120 minutes after intravenous injection of 4 MBq/kg of ¹⁸F-Dopa. Scintigraphic images were visually interpreted. For quantitative analysis, maximum standardized uptake value (SUV_max) per focus was employed. PET results were compared with histological findings and/or with the results of all other imaging procedures.

Results

Seven patients (70%) had a positive ¹⁸F-Dopa PET/CT. Twenty-five focal tracer accumulations were described. Histopathological confirmation of metastatic disease was obtained in four of the seven patients with pathologic ¹⁸F-Dopa PET/CT. No scintigraphic abnormalities were evidenced in the three other patients, whose conventional morphological imaging procedures were also negatives. Delayed PET/CT examinations didn’t increase sensitivity. No correlation between ¹⁸F-Dopa PET/CT results and both serum calcitonin and CEA levels was achieved.

Conclusion

Our results are in accordance with the existing literature, showing the potential role of ¹⁸F-Dopa PET/CT in the clinical management of patients with history of MTC and biological suspicion of relapse during post-surgical follow-up. Prospective studies including larger patient series are necessary to confirm the future place of ¹⁸F-Dopa PET/CT in follow-up of MTC.     

¿Carcinoma de mama o carcinoma de glándula sudorípara? Presentación de dos casos y análisis de la literatura

Primary apocrine carcinoma of the sweat gland is a neoplasm with a very low incidence that may represent a clinical and histological diagnostic challenge, as well as for adequate local, adjuvant, and advanced disease management. The average age of patients is around 67 years with no gender preference. This cancer develops primarily at the axillary and scalp levels and is clinically characterized by slow growth, but can progress aggressively with local, nodal, and metastatic involvement (primarily lung, liver, and bone). The recommended management, once the histology is established, consists of a wide local resection with a clear margin of 1 to 2 cm and regional lymphadenectomy if clinically positive nodes are detected. The adjuvant treatment (radiotherapy or chemotherapy) and for the advanced disease is not established.We report here the cases of two female patients initially diagnosed with breast cancer who were finally diagnosed with apocrine carcinoma of the sweat gland.     

¿Qué pacientes se benefician más de la atención geriátrica hospitalaria en opinión de los especialistas en Geriatría?

Objective

To assess the most appropriate criteria considered by geriatricians to select patients who might benefit the most from geriatric hospital care.

Material and methods

We carried out a survey that consisted of various socio-demographic, clinical, functional and mental criteria included in the definition of the geriatric and frail elderly patient. The survey was sent to all specialists in geriatrics in the different hospitals of the Madrid Health Service. They were asked to answer to each criterion indicating whether they considered it as high priority, priority, low priority or no priority. The responses were clustered by type of hospital: acute hospitals with or without a post-graduate geriatric program for medical residents, and medium and long stay hospitals.

Results

A total of 83 questionnaires were completed (70% of the study population): 42 teaching hospitals a post-graduate geriatric program (74% of possible), 20 of those with an emergency department but without a post-graduate geriatric program (56% of possible), and 21 medium and long stay hospitals (84% of potential). All proposed criteria were considered individually as priority or high-priority by more than 50% of respondents. An age 85 years and over, admission for hip fracture, the presence of severe cognitive or functional impairment, frailty, and unexplained deterioration of health status, were considered individually as criteria for selecting high-priority target population by more than 85% of respondents.

Conclusions

Certain criteria, such as advanced age, or the presence of geriatrics-specific conditions, such as hip fracture or severe functional or cognitive impairment, are identified by geriatricians as useful to select patients to receive geriatric specialist hospital care.     

¿Está la miastenia gravis infradiagnosticada en los mayores de 80 años? A propósito de 2 casos

Myasthenia gravis (MG) is diagnosed more often today than previously. The increase is mainly found in patients over the age of 60 years. Recent data indicate that MG may still be substantially underdiagnosed in very old people. We report two cases of MG in elderly women, in whom the initial diagnosis was uncertain. When faced with new onset of weakness in an elderly patient, particularly of cranial musculature, clinicians should consider MG as a diagnostic possibility.     

Analyse comparative de 3 logiciels de reconstruction itérative de tomoscintigraphie monophotonique myocardique

ObjectiveThis study makes a comparative analysis of the quality reconstruction of three software: 2D ordered subset expectation maximisation (2D OSEM), 3D ordered subsets expectation maximisation (Flash 3D) and Wallis.Patients and methodsThe data from myocardial scintigraphy acquisitions of 50 patients (38 men and 12 women; average age 61 ± 9 years) were successively reconstructed using three myocardial perfusion SPECT algorithms (Flash 3D, OSEM 2D and Wallis). Different combinations of iterations and subsets were considered. For Wallis, only the cut-off frequency was considered. The image's quality was assessed by determining the maximum contrast and the signal to noise ratio.ResultsThe Wallis software provided a higher signal to noise ratio compared to Flash 3D and OSEM 2D at stress and rest. The Wallis signal to noise ratio increased by a factor 1.93 (P = 0.0010) and 2.28 at stress (P = 0.0009); 1.50 (P = 0.0011) and 2.84 at rest (P = 0.0024) compared to respectively Flash 3D and OSEM 2D. Flash 3D provided better signal to noise ratio than OSEM 2D at stress and at rest. The difference in medians and interquartile ranges of the signal-to-noise ratio in post-stress were 22 % and 54 %, respectively between Flash 3D and OSEM 2D. At rest, the difference between the two methods in signal to noise ratio was 32 % ± 0.,29.ConclusionWallis algorithm was improve image quality with better signal to noise ratio compared to the reference method of Siemens Flash 3D. For both Flash 3D and OSEM 2D methods, the combination with 8 subsets and 12 iterations provided the best contrast and signal to noise ratio.     

Cancer différencié de la thyroïde métastatique à propos de 70 cas : impact des nouvelles recommandations de 2017

IntroductionMetastatic differentiated thyroid carcinoma (MDT) represents an average of 10% of patients with CDT. Metastases are prognostic factors. Their care is multidisciplinary.ObjectiveTo study the epidemiological, clinical, histological, therapeutic and evolutionary aspects of metastatic CDT and to study the impact of new recommendations.Patients and methodsRetrospective study of 70 patients followed for a metastatic CDT collected between June 2007 and June 2017, in the nuclear medicine department of Hassan II University Hospital of Fez.ResultsMean age 51.34 ± 15.96 years, sex ratio F:H: 2.5. Age > 45 years old at 65.7% of whom 42.8% > 55 years old. Circumstances of discovery: nodule 15.8%, multi-hetero-nodular goiter 17.1%, metastases 65.7%. Multivariate analysis shows a significant correlation of age greater than 45 years (P: 0,001) and revealing metastasis. Histology: papillary carcinoma 72.9%, vesicular carcinoma 22.8% and carcinoma poorly differentiated 4.3%. Tumor > 4 cm in 45.7%, the TNM classification (2010) vs. TNM classification (2017): 31.4% vs. 48.6% in stage I, 12.9% vs. 28.6% in stage II, the stage III in 17.1% vs. 0% and 38.6% vs. 22.8% in stage IV. Complementary investigations: localization of metastases: 40% at the bone level, 31.4% lung, 14.3% ganglionnaires and others 9.9%. Hormonal braking treatment was administered in all patients and the « irathérapie » (ATA vs. French recommendation 2017).EvolutionSeven cases of cure, 1 case of recurrence, 4.3% refractory to iodine.ConclusionThe presence of metastases, worsens the prognosis. Therapeutic de-escalation with French recommendations. Bone localization was predominant, its management is multidisciplinary, and radioactive iodine as a complementary treatment does not allow their healing.     

Purification de l'alcool deshydrogénase de tomate par chromatographie d'affinité

Tomato alcohol dehydrogenase has been purified 99-fold by affinity chromatography on Blue Sepharose CL-6B with 37% yield. The enzyme so obtained is homogenous in polyacrylamide gel electrophoresis. By adding 20% glycerol to the extraction and purification buffers, an enzyme is obtained which is stable for several months at 4°. The molecular weight values determined by gel filtration (Sephadex G 200) and polyacrylamide gradient gel electrophoresis on one hand and by polyacrylamide gel electrophoresis in sodium dodecyl sulfate on the other, show that the enzyme exists in dimeric form.     

Évaluation de la réponse au traitement du lymphome avec la TEP F-FDG : existe-t-il un consensus dans l’évaluation de la réponse ?

The concept of risk-adapted therapy in lymphoma is increasingly accepted as a way to achieve higher cure rates with a lower or equal risk of treatment-related morbidity and mortality. Tailoring and individualizing therapy according to the need of the patient is a therapeutic option which could maybe soon become the standard of care. However, it is still not proven that modifying therapy based on interim-PET can improve patient outcomes. Therefore, this issue must be analyzed in appropriately designed clinical trials. ¹⁸F-FDG PET enables evaluation of the early metabolic changes rather than the morphologic changes which occur later during therapy. In lymphoma these early metabolic changes are highly predictive of the final treatment response. PET performed after a few courses of standard chemotherapy is a reliable prognostic tool to identify poor responders to therapy. Interim-PET is a powerful prognostic tool when compared to other well-established clinical parameters in lymphoma. However, the major drawback in the literature appeared to be related to the lack of uniform and reliable criteria for interim-PET scan interpretation. Therefore, in April 2009 an international meeting took place in Deauville (France), where uniform criteria were established for interim-PET scan interpretation. On the other hand, when PET is used to assess treatment response after completion of therapy, the criteria established in the International Harmonization Project in 2007 must be applied. These recommendations were designed to standardize the interpretation of interim PET and PET at the conclusion of therapy of patients with lymphoma both in clinical practice and clinical trials.     

La fuerza de prensión manual: ¿puede ser un factor pronóstico de mortalidad en cuidados paliativos?

Objective

To determine whether hand grip strength (HGS) is a prognostic factor for mortality in a palliative care unit (PCU), using two variables: A1: The HP on admission; A2: The progression of the HGS in the first 12 days of admission.

Material and methods

A prospective, observational and comparative study of patients with advanced cancer admitted consecutively over a 4 month period into a PCU. A series of 4 determinations of HGS were made using a JAMAR^® 5030J1 dynamometer. A total of 78 patients fulfilled the inclusion criteria, of which 61 (78.2%) agreed to take part.

Results

Objective A1: Of the 61 enrolled patients, the survivors (n = 25) differed by -1.8 (Standard Deviation (SD) 0.8) from the reference values for age and gender, and for those that died (n = 36) it was -1.9 (1.1) (P = .6). A survival analysis was performed with this sample. The sample was subdivided into those who were > -2 SD (n = 34) and those < -2 SD (n = 27) (P = .3). Those patients who managed 4 determinations (n = 49) were included in objective A2. At discharge there were 26 deaths and 23 alive. There were no statistically significant differences between the determinations. Only the comparison between the difference between the 4th and 1st determination in the two groups showed a significant result (P = .01).

Conclusions

The HGS measured at admission, as well as in the first 12 days, was not a prognostic factor for mortality in the sample studied.     

Douleurs thoraciques et scintigraphie myocardique : à propos de 171 cas

Study aimTo find a correlation between epidemiological factors, risk factors and history and the results of myocardial scintigraphy according to the type of pain and discuss the role of scintigraphy in the diagnosis and therapeutic care.Patients and methodsOur study is retrospective, on 171 patients with typical chest pain (TCP) or atypical (ACP), addressed for myocardial scintigraphy.ResultsFemale predominance was clear. Average age was 59 years. Frequency of risk factors: smoking, diabetes, hypertension, hyperlipidemia, history of heart disease and hypothyroidism was respectively 21.6%, 39.8%, 73.7%, 25.1%, 11.1% and 6.4%. ACP was found in 57.9% of patients, it was more common among women (59.8%). Scintigraphy was abnormal in 36.8% of patients. Scintigraphy was normal in 59.7% of patients with TCP. In the case of ACP, scintigraphy was normal in 65.7%. This difference is not significant. All patients having abnormal scintigraphy had abnormal coronary angiography with a statistically significant correlation. Normal scintigraphy was more frequent (83.3%) in young patients ( < 40 years) and more common in women (67%) than men (55.9%). The sensitivity of scintigraphy is 100%. Its specificity is 66.6%. Its PPV of 57.1%. Its VPN is 100%.ConclusionMyocardial scintigraphy can help clinicians to identify the etiologic diagnosis and assess the prognosis of chest pain.     

Valbro : un nouveau site à vertébrés de l’Oligocène inférieur (MP 22) de France (Quercy). II – Oiseaux (Aves)

The bird remains from Valbro belong only to three taxa, Paraortyx lorteti, Archaeotrogon venustus, and A. zitteli. This association makes it possible to ascribe to this locality an early Oligocene age, reference-levels MP 22 or MP 23, which is in agreement with the age given by the mammals.     

Action de l'ecdystérone sur l'apolysis et l'ecdysis de divers crustacés isopodes

Ecdysterone acts differently according to the period of the moulting cycle when it is applied. In period C it induces apolysis, while at the beginning of apolysis it delays ecdysis. Experiments show that the exoskeleton cannot be rejected in the presence of ecdysterone. The possibility of stopping exuviation or ecdysis with ecdysterone seems to prove that this phenomenon is controlled by a particular factor called the factor of exuviation or the ecdysis factor. Ecdysterone would control only the release of this specific factor but would not prevent its action.     

Mensurations échographiques de la thyroïde chez des enfants de zéro à 15 ans de la ville de Ouagadougou

Among the methods used to carry out measurements of thyroid, echography is the best because it is noninvasive and more specific. The goals of this study were to determine the normal thyroid volume of the Burkinabe child; to study the parameters which induce a variation of thyroid volume and to compare our values with those from other localities. Through a cross-sectional study, 240 children from the town of Ouagadougou benefited from a thyroid echography. Thus the height (h), the transverse diameter (dt) and the thickness (e) were measured. Volume (vl) of each lobe was estimated by: vl = h × dt × e × 3.14/6. The total volume (VT) is the sum of the volumes of each lobe, the isthmus being neglected. A correlation set at the threshold p < 0.001 has been carried out between VT and some anthropometric parameters. The following averages were observed: before one year, the average volume is of 0.51 L ± 0.21; from one to three years, it is of 0.95 mL ± 0.33; from four to six years, the average volume is of 1.35 mL ± 0.43; from seven to nine years, it is of 1.95 mL ± 0.62. From 10 to 12 years, the average volume is of 3.01 mL ± 1.08 and it is of 5.32 mL ± 2.07 from 13 to 15 years. It stands out that the VT is positively associated with the age (r = 0.82), with the size (r = 0.73), with the weight (r = 0.81) and with body surface (r = 0.78). Moreover, the VT is higher among boys than in girls beyond one year of age. This parameter varies according to the area of origin. Lastly, compared with the American, European and Asian averages, our values are smaller. This study enabled us to establish our own standards which we will be able from now on to use in daily practice. However, multicentric studies associated with thyroid and sexual hormones blood levels measurements must be undertaken to ascertain these data.     

Une histoire de géométrie et de finesse (ou : comment parler de phylogénétique ?)

The development of phylogenetic methods since the beginning of the 1970s is analyzed through Armand de Ricqlès’ comment, in 1975, on the triumph of the spirit of geometry over the spirit of finesse. Cladistics was then compared to geometry (Hennig's congruence [i.e. congruent character-state trees]). However, the qualitative aspect of anatomy (spirit of finesse) warrants the quality of a taxon × character matrix so that minimal length trees were never devoid of finesse. Statistical approaches, especially maximum likelihood and Bayesian methods, with sophisticated mathematics (more rigorous geometry?), have reached a wide acceptance after years of debates hindered by polemics. The molecular trees based on these approaches are now dominating the phylogenetic literature, although these trees too include some ambiguity so that one can wonder: do evolutionary models belong to geometry or finesse?     

Contexte géographique et géologique du site de Kocabaş, Bassin de Denizli,Anatolie, Turquie

The site of Kocaba? is located in the Denizli Basin, in western Anatolia, 400 km southwest of Ankara, 360 km south of Istanbul, 200 km east-southeast of Izmir and 150 km northwest of Antalya. The Denizli Basin depression, at the junction of the Buyuk Menderes and Gediz grabens, which began to form at the beginning of the Miocene, was filled in around the edges, along fault lines, by significant travertine formations, some of which are still active today. The age of the Kocaba? travertines, which yielded the Kocaba? Homo erectus skullcap, was evaluated by thermoluminescence at 828,000 years, by electron spin resonance (ESR) at 1,110,000 years and by the ²⁶Al/¹⁰Be cosmogenic nuclide method to more than 1.22 Ma and less than 1.5 Ma, a date which has been confirmed by magnetostratigraphy and biochronology.     

Influence de la rhTSH sur la fixation du 18 FDG dans une population de 42 patients avec cancer différencié de la thyroïde suspect de récidive

PurposeThe role of positron emission tomography with 18 fluoro-deoxy-glucose (FDG-PET) in case of differentiated thyroid carcinoma recurrence is established. However, the influence of TSH levels on 18 FDG is still discussed. Our study aims at comparing respective performances of FDG-PET performed at low TSH levels and under rhTSH stimulation, when a recurrence of a thyroid carcinoma is suspected.Material and methodsForty-two patients have been included, in a prospective way; each of them has been explored by FDG-PET at low (PET1) and high TSH levels with Thyrogen^® (PET2). The number of hypermetabolic foci, the intensity of uptake, both visual and with Standardized Uptake Values (SUV) have been compared.ResultsPET1: 82 foci were detected, including 75 true positive (TP) and seven false positive (FP). Sensitivity by lesion is 85.23 and 58.6% on a patient basis. Twelve pathological sites, not visualized (false negative) in PET1, were seen under stimulation. PET2: 89 foci were detected, including 87 TP and two FP; two tumoral sites visualized with PET1 are not detected. Sensitivity by lesion is 97.75 and 75.9% on a patient basis. SUV are significantly higher under stimulation. In three patients, therapeutic strategy has been modified, based on PET2 data.ConclusionStimulation by rhTSH improves FDG-PET performances. Therefore, it is justified to resort to it in case of recurrence of differentiated thyroid carcinoma, when the usual workup is negative.     

Conclusion. Bilan des recherches interdisciplinaires effectuées sur le site de l’Homo erectus de Denizli,Kocabaş, Bassin de Denizli,Anatolie, Turquie. L’Homo erectus aux portes de l’Europe

The study of the site of Kocaba?, which yielded an archaic Homo erectus skullcap, was undertaken in 2011 and 2012, at the request of Professor Mehmet Cihat Alçiçek. This interdisciplinary French–Turkish research programme comprised the geochronological, magnetostratigraphic, biochronological and paleoenvironmental study of the site and the paleoanthropological study of the skullcap itself. The association of large mammals enabled us to attribute the travertine formations bearing the skullcap to the second part of the Upper Pleistocene, and more specifically to between 1.5 and 1.2 million years, because of the disappearance or appearance of certain species. This biochronological age is confirmed by the paleomagnetism study, which places the travertines bearing the skullcap in a period of reversed polarity, underlying a normal polarity formation, which could be attributed to the Cobb Mountain paleomagnetic excursion, dated to 1,194,000 years. The dating of these fauna by the ²⁶Al/¹⁰Be cosmogenic nuclide method by Anne-Elisabeth Lebatard yielded an age older than 1.22 Ma and more recent than 1.5 Ma. The Hominid skullcap from this formation can be attributed to a Homo erectus, slightly more evolved than those of Homo ergaster KNM-ER 3733 (1.78 Ma) and KNM-ER 15,000 (1.5 Ma), similar to that of Daka (Bouri), which is about a million years old and older than the Bodo fossil (estimated at 600,000 years) and Kabwe (between 300,000 and120,000 years). The archaic Homo erectus skullcap from Kocaba?, referred to as Denizli Man, proves that Homo erectus was already present in Anatolia, at the crossroads of Africa, Asia and Europe, a little more than 1.2 million years ago.     

Action de l'antimycine a sur l'activité succinoxydase des mitochondries du tubercule de Pomme de Terre,et comportement des cytochromes de type b

A kinetic study of the effect of antimycin A on succinate oxidase from plant mitochondria produced sigmoidal curves for the reduction of cytochromes b₅₆₀ and b₅₈₅ and for the inhibition of succinate oxidase. In the stationary state the interaction of the various components of the respiratory chain (flavins, ubiquinone, cytochromes…) occurs in a sequential mode which allows the application of simple equations utilizing rate constants and cytochrome concentrations. In these equations, it is assumed that there exists an excess of ubiquinone relative to other components of the respiratory chain as suggested by Kröger & Klingenberg (1970) and that the reoxidation of b cytochromes is fast. The inhibition by antimycin A, characterized by non-linear inhibition curves for succin-oxidase and inhibitor fixation in complex III on a component other than cytochrome c₁, is interpreted in terms of this model. This hypothesis presupposes the existence of an F factor between cytochrome b₅₆₀ and cytochrome c₁ as suggested by other authors. Utilizing these equations, theoretical curves for the inhibition of the reduction of cytochrome b₅₆₀ have been constructed and the results agree with the experimental data. The kinetic behavior of cytochrome b₅₆₆ during the induction of anaerobiosis suggests that it is not directly involved in the electron transfer chain but rather is either in thermodynamic equilibrium with cytochrome b₅₆₀ or in a shunt between cytochrome b₅₆₀ and factor F. From the experimental data, an equation is derived for the inhibition of the reduction of cytochrome b₅₆₆ by antimycin A. The actual effects of ATP and mClCCP on succinoxidase agree well with those predicted by the model.