TEP au 18-FDG et carcinose péritonéale d’origine ovarienne : valeurs diagnostique et pronostique avant chimio-hyperthermie intra-péritonéale (CHIP)

AimEvaluate 18-FDG PET/CT diagnostic and prognostic value before HIPEC.Materials and methodsThis retrospective monocentric study included 38 patients with recurrent (n = 27) or primary (n = 11) ovarian cancer who were blinded reviewed for the presence of peritoneal lesions on PET/CT before HIPEC treatment. The results were compared to surgical and histopathological findings, and to survival curves.ResultsThirty-two patients had peritoneal carcinomatosis based on surgical and histopathological findings, and 19 based on PET. There was no suspicious site of abnormal FGD uptake in the supradiaphragmatic regions. The sensitivity and specificity were respectively 56.2 and 100%. Among the 14 false negative patients, 11 had infracentimetric peritoneal implants, and most of them (n = 13) had chemotherapy before HIPEC. There was significantly more patients treated by chemotherapy in the negative PET group (P = 0.02). Even if the event rate observed was higher in the positive PET group for both event free and overall survival (respectively 68% vs. 64% and 26.3% vs. 17.6%), no significant difference was observed using the survival curves (respectively P = 0.62 and 0.59).ConclusionFDG PET/CT before HIPEC showed excellent specificity and lower sensitivity, due to small peritoneal implants and probably to chemotherapy before HIPEC. No significant prognostic value of FDG PET was observed in our study. FDG PET could be considered as a useful tool for detecting distant metastasis with an impact on therapeutic management.     

Intérêt de la TEP/TDM dans le diagnostic de la carcinose péritonéale : à propos d’une observation

PET/CT is a significant examination recognized in the detection of tumors and their metastases. Through a rare case of peritoneal carcinomatosis complicating an endometrial carcinoma, the authors discuss utility of FDG-PET/CT in the diagnosis and follow-up of this disease.     

La toxicité rénale du lithium: une réévaluation

Lithium salts are a well-established prophylactic treatment of relapses in bipolar disorder. Their most common renal side-effect is nephrogenic diabetes insipidus leading to polyuria. Only recently has their undesirable effect on renal function been recognized. This effect is due to the development of renal tubulo-interstitial lesions. The rate of progression is slow, with an annual loss of glomerular filtration estimated to be 2.2 ml/min. End-stage renal disease has been reported in some patients. In France, a recent survey showed that 0.2% of dialysed patients had lithium-induced renal disease. This complication occurs in a small percentage of lithium-treated patients, after 1 or 2 decades of treatment. However, its exact prevalence in the long-term is unknown. Lithium-treated patients should be regularly monitored. This monitoring should include annual measurements of serum creatinine and estimated creatinine clearance, as well as measurements of serum calcium (because hyperparathyroidism may develop). In early renal toxicity, discontinuation of lithium should be discussed with the patient by both the treating psychiatrist and the nephrologist.     

« Du gris clair au gris foncé… » Exploration de la carcinose péritonéale par TEP-TDM

FDG or Fdopa PET/CT is a powerful imaging technique for detection and characterization of peritoneal carcinomatosis. Diagnosis features and main differential diagnoses are presented from clinical reports.     

Expérience clinique avec une épreuve de réserve hypophysaire

A test of pituitary reserve was used in the investigation of 14 children with retarded growth and 15 adults with endocrine disorders. Mepyrapone (Metopiron), 500 mg. every four hours, was administered orally for 48 hours. The pituitary response was determined by the amount of 17-hydroxycorticosteroid in a 24-hour urine sample (by a modification by Peterson of the Porter-Silber method). Pituitary reserve was decreased in four patients who were pituitary dwarfs, one who had retarded growth, two patients with Sheehan''s syndrome, three with pituitary tumours, one who had panhypopituitarism without a tumour, and one case of limited adrenal reserve (confirmed by a negative response to ACTH stimulation). The pituitary reserve was normal in three patients with gonadal dysgenesis, three who exhibited retarded growth, one case of diabetes insipidus, one cretin, one patient treated by steroids, three with psychogenic amenorrhea, and five normal controls. It is concluded that this test of pituitary reserve is useful in the assessment of children with growth retardation and in establishing the diagnosis of pituitary insufficiency in adults.     

Tumeurs brunes multiples révélant une hyperparathyroïdie primaire

Primary hyperparathyroidism is a common disease, especially in post menopauses women. Because of the determination of serum calcium and parathyroid hormone, the diagnosis is most often established either in an asymptomatic patient, either in the work-up of osteoporosis. We report the clinical case of a patient in whom primary hyperparathyroidism was revealed by multiple brown tumors and hypercalcemia rising at 3.1 mmol/L.     

Le sujet cérébral: une esquisse historique et conceptuelle

Since the middle of the 20th century, numerous discourses and practices, both within and outside scientific and philosophical disciplines, have manifested the development of the notion of the human being as acerebral subject. The brain appears to be the only organ of the body that we need, and that has to be exclusively ours, in order for each individual to be himself or herself. Sincepersonhood is the quality or condition of being an individual person,brainhood is thus the quality or condition of being a brain. This property defines the cerebral subject. The anthropology ofbrainhood may seem a natural consequence of progress in the neurosciences. However, it is rooted in 17th-century developments in the philosophies of matter and personal identity. The neurosciences confirm and reinforce this perspective. The author outlines the historical narrative concerning the development of the cerebral subject as well as some contemporary issues arising from the neurosciences.     

Quelques champignons pathogènes,isolés du sol roumain,par la méthode de l'inoculation intrapéritonéale à la souris

Resumé En injectant, selon le procédé d'Ajello et al., dans la cavité péritonéale de la souris blanche, une suspension de terre prélevée de divers endroits et en ensemençant après un délai de 6 à 8 semaines des fragments du foie, de la rate, des poumons et des reins de l'animal inoculé, les auteurs ont décelé dans le sol roumain la présence des champignons suivants:Geotrichum candidum, Trichophyton mentagrophytes, Keratinomyces ajelloi (une souche pathogène) etCoccidioides immitis. Selon les auteurs, cette méthode d'isolement est capable de compléter la méthode deVanbreuseghem pour l'isolement des dermatophytes du sol. La présence duCoccidioides immitis dans le sol roumain mérite une mention spéciale, la coccidioidomicose étant, jusqu'en 1961, inconnue en Roumanie.

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Summary By injecting the supernatant from aqueous suspensions of different rumanian soil specimens intraperitoneally into white mice and subsequent culture of their livers and spleens, according to the procedure ofAjello et al., the authors were able to recover the following fungi:Geotrichum candidum, Trichophyton mentagrophytes, Keratinomyces ajelloi (a pathogenic strain) andCoccidioides immitis (two strains). In the author's opinion, this indirect isolation procedure may complete the method developed byVanbreuseghem for isolating dermatophytes from soil. The presence ofCoccidioides immitis in the rumanian soils needs special mention owing to the fact that coccidioidomycosis was unknown in Rumania until 1961.

     

Productions lithiques et comportements techno-économiques de groupes humains acheuléens et moustériens en région liguro-provençale

Acheulean and Mousterian human occupations left an abundant record of lithic productions in the Liguro-Provençal region. Certain sites show the transition between the Lower and Middle Palaeolithic, yielding industries in which the shaping of bifaces continued along with partial Levallois reduction and the development of light-duty, retouched Mousterian tools. In the more recent sites, Mousterian lithic productions show further development in Levallois reduction techniques and sometimes blade production, while shaping techniques disappeared. The transport of artefacts of exotic lithic raw materials from sometimes very distant sources had already occurred by the end of the Acheulean, and the example of the use of allochthonous jasper illustrates an aspect of techno-economical behaviours and the mobility of these human groups. Such transport of jasper blanks from distant sources became further developed at certain Mousterian sites in Liguria, but with the addition of knapping and retouching activities at the occupation sites.     

Création d'une lignée homozygote pour une translocation réciproque chez l'Amphibien Pleurodeles waltlii

Résumé Chez le Pleurodèle, une étude cytogénétique portant sur quatre géné-rations successives a permis d'obtenir une lignée stable d'individus féconds homozygotes pour une translocation réciproque.L'anomalie a d'abord été décelée à l'état hétérozygote chez une femelle résultant du croisement entre une femelle normale et un mâle irradié aux rayons X. Le remaniement chromosomique initial consiste en un échange réciproque de segments inégaux entre le bras court d'un chromosome 5 et le bras long d'un chromosome 6. Il en résulte un allongement du bras court d'un chromosome 5 correspondant à un raccourcissement d'égale amplitude du bras long d'un chromosome 6, soit la formule 24, t(5p+; 6q-) par analogie avec le système utilisé pour les caryotypes humains.Contrairement à ce que l'on aurait pu supposer, la ségrégation des chromosomes remaniés n'est pas perturbée au cours de la méïose des animaux 24, t(5p+;6q–).Lors des croisements entre un individu hétérozygote pour la trans-location et un individu normal ou entre deux hétérozygotes, la descendance est constituée de germes phénotypiquement normaux ou anormaux selon leur constitution chromosomique.Les sujets 24, t(5p+; 6q–) et 24, 2(5)–, 2(6)–,2(5p+) +, 2(6q–)+ ont un caryotype équilibré, leur phénotype est normal. Les formules déséquilibrées sont par contre léthales ou semi-léthales.Les embryons 24, 6–, (6q–)+ et 24, 5–, 2(6)–, 5p+, 2(6q–)+ présentent rigoureusement le même syndrome. Ils meurent peu de temps après l'éclosion sans pouvoir se nourrir. Les ébauches branchiales sont pratiquement inexistantes, l'il est malformé et la bouche reste béante.Les deux formules 24, 5–, (5p+)+ et 24, 2(5)–, 6–, 2(5p+)+, (6q–)+ déterminent de même un autre syndrome caractéristique. Dans ce cas, chez les embryons âgés et les jeunes larves, les malformations sont discrètes et transitoires. Elles se situent au niveau des yeux et des branchies. Il est difficile d'élever ces animaux jusqu'à l'âge adulte. Ceux qui survivent ont un corps disproportionné et des anomalies du squelette vertébral.Les deux formules 24, 2(6–), 2(6q–)+ et 24, 2(5)–, 2(5p+)+ ont un déséquilibre tel que les embryons ne dépassent pas le stade de la gastrula.L'examen des figures méïotiques de mâles hétérozygotes pour l'anomalie confirme les résultats obtenus à partir de l'étude des phénotypes et des caryotypes des descendants. La première division méïotique comporte 10 bivalents et un tétravalent tandis que l'examen des caryotypes établis à partir des métaphases II montre qu'il ne se forme que quatre types différents de gamètes.Le chromosome 6q– se reconnaissant aisément à l'examen microscopique direct, la translocation constitue un marqueur nucléaire facilement utilisable car les individus homozygotes pour l'anomalie ont une croissance et une méïose normales.

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A homozygous reciprocal translocation in a strain of the newt Pleurodeles waltlii

A cytogenic study dealing with four generations of the newt Pleurodeles waltlii has lead us to a stock of fertile homozygotes for a reciprocal translocation. —The chromosomal rearrangement has first been detected at the heterozygous state in a female resulting from a cross between a normal female and a male submitted to X ray-irradiation. The initial aberration consists of a reciprocal exchange of unequal segments between the short arm of a chromosome 5 and the long arm of a chromosome 6. Consequently, the short arm of chromosome 6 grows shorter in the same proportion (formula 24, t(5p+; 6q–), on the analogy of the human chromosome standardization).—Against all expectation, meiosis in 24, t(5p+;6q–) animals leads to a normal segregation of abnormal chromosomes.—When a heterozygote for translocation is bred with a normal individual or when two heterozygotes are crossed, the offspring is composed of phenotypically normal or abnormal animals, depending on their karyotypes.—The subjects 24, t(5p+; 6q–) and 24, 2(5) –, 2(6) –, 2(5p+) +, 2(6q–)+ have balanced karyotypes; their phenotype is normal. On the other hand, the unbalanced types are lethal or semi-lethal.— The 24, 6–, (6q–)+ and 24, 5–, 2(6) –, 5p+, 2(6q–)+ embryos show a strictly identical syndrome. They die soon after the hatching stage without having been able to eat. The branchial outlines are almost inexistant, the eyes are poorly-formed and the mouth stays wide-open.—The two formulas 24, 5-, (5p+)+ and 24, 2(5) –, 6 –, 2(5p+)+, (6q–)+ produce the same phenotypic aberrations as well. In this case, malformations in older embryos and young larvae are discrete and transient. They are localized at the eye and branchial levels. It is difficult to rear these animals until adulthood. Those that survive, have a disproportionate body and malformations of the vertebral skeleton.—The two formulas 24, 2(6) –, 2(6q–)+ and 24, 2(5) –, 2(5p+) + are so unbalanced that the embryos do not survive beyond the gastrula stage.—The study of the meiotic slides of male heterozygotes bring a cytologie confirmation to the results obtained from the study of the phenotypes and karyotypes established on the offspring. The first meiotic division shows 10 bivalents and one quadrivalent, whereas the study of the karyotypes from the metaphases of the second meiotic division prooves that only four types of different gametes can be formed.—The 6q– chromosome is easily recognizable under direct microscopic study. This translocation constitutes a nuclear marker which can be easily used because the homozygotes for the aberration grow normally and show a normal meiosis.

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Cet article recouvre en partie le travail d'une thèse de Doctorat d'Etat de Sciences naturelles qui sera soutenue dans le courant de l'année 1971.