Evaluation of sentinel lymph node biopsy after previous breast surgery for breast cancer: GATA study.

AIM: Sentinel lymph node (SLN) biopsy was recently recommended after prior breast tumour surgery and lymphadenectomy is not the gold standard anymore for nodal staging after a lesion's removal. The purpose of our study was to evaluate the good practices of use of SLN biopsy in this context. PATIENTS AND METHODS: From 2006 to 2012, 138 patients having undergone a surgical biopsy without prior diagnosis of an invasive carcinoma with a definitive histological analysis in favour of this diagnosis were included in a prospective observational multicentric study. Each patient had a nodal staging following SLN biopsy with subsequent systematic lymphadenectomy. RESULTS: The detection rate of SLN was 85.5%. The average number of SLNs found was 1.9. The relative detection failure risk rate was multiplied by 4 in the event of an interval of less than 36 days between the SLN biopsy and the previous breast surgery, and by 9 in the event of using a single-tracer detection method. The false negative rate was 6.25%. The prevalence of metastatic axillary node involvement was 11.6%. In 69% of cases only the SLN was metastatic. The post-operative seroma rate was 19.5%. CONCLUSION: Previous conservative breast tumour surgery does not affect the accuracy of the SLN biopsy. A sufficient interval of greater than 36 days between the two operations could allow to improve the SLN detection rate, although further studies are needed to validate this statement. CLINICAL TRIAL REGISTRATION NUMBER: NCT00293865.

[Determination of ciprofloxacin in human serum by high-performance liquid chromatography]. / Dosage de la ciprofloxacine en milieu sérique par chromatographie liquide haute performance.

A high-performance liquid chromatography method was developed for the rapid determination of ciprofloxacin in human serum. After protein precipitation, chromatographic separation of ciprofloxacin in plasma was achieved with an octyl column and 20 mmol/L phosphate buffer, methanol and acetonitrile 76/12/12 (v/v/v), pH 4, as mobile phase. Quantitative determination was monitored on a fluorescence detector using an excitation and emission wavelength of 278 and 450 nm, respectively. Enrofloxacin was used as internal standard. Calibration curve is linear over the range 0,12 to 20 microg/mL (r=0,9992). Limit of detection and limit of quantification are 0,04 and 0,12 microg/mL, respectively. Within-day coefficient of variation (2,0 to 3,1 %) and day-to-day coefficient of variation (4,3 to 5,5 %) at three different concentrations are sufficient. Relative recovery ranged from 91,1 to 94,0 % at three different concentrations. Each analysis requires no longer than 7 min.

[Coma in type 2 diabete mellitus on metformin treatment]. / Coma chez un diabétique de type 2 traité par la metformine.

Non traumatic coma in diabete mellitus has two origins : hypo- or hyperglycemia. Coma with hyperglycemia can be due to ketoacidosis, hyperosmolar state or lactic acidosis. The present observation reports on a type 2 diabete mellitus patient presenting with a coma while the patient was on metformin and glibenclamide treatment. On admission, biologicals tests showed major acidosis, hyperglycemia and hyperosmolarity. No metformine accumulation was demonstrated by analytical measure. In this case, the association of hyperosmolar state and metabolic acidosis prove the difficulty of the differential diagnosis.

[Interference of hydroxocobalamine treatment on commun biochemical determinations]. / Interférence de l'hydroxocobalamine sur les résultats des dosages biochimiques usuels.

Hydroxocobalamin, antidote of the cyanide poisoning, is a red and water soluble pigment, which colors biological mediums. The interferences caused by this molecule are studied for plasma pools overloaded with hydroxocobalamin for concentrations from 0 to 1,125 mg.L-1. The results of 16 biochemical parameters on Vitros 750 XRC (Ortho-clinical Diagnostics) and of 23 biochemical parameters on Cobas Integra 700 (Roche Diagnostics) are examined. With this analytical system, unconjugated and conjugated bilirubin, creatinin, and CK results are changed as soon as plasma concentration of hydroxocobalamin reachs 124 mg.L-1. For the Vitros 750 XRC, ASAT, iron, creatinin, phosphorus are more sensitive to this interference. But, other results are changed for the two analytical systems for superior hydroxocobalamin concentrations.

Prevalence of drugs of abuse in urine of drivers involved in road accidents in France: a collaborative study.

The collaborative, anonymous, case-control study was intended to determine the prevalence of opiates, cocaine metabolites, cannabinoids and amphetamines in the urine of drivers injured in road accidents and to compare these values with those of non-accident subjects ("patients") in France. Recruitment was performed nationwide in the emergency departments of five hospitals and comprised 296 "drivers" aged 18 to 35 and 278 non-traumatic "patients" in the same age range. Females represented 28.4% of "drivers" and 44.2% of "patients." Screening for drugs in urine was performed by fluorescence polarization immunoassays in each center. Each positive result was verified using gas chromatography-mass spectrometry (GC-MS), in a single laboratory. Statistical analysis comprised single-step logistic regression and simultaneously took account of confounding factors and the final differences in prevalence values between the two populations or different subgroups. Cannabinoids were found in 13.9% of drivers (16.0% of males and 8.3% of females, p < 0.05) and 7.5% of patients (12.3% of males, 1.6% of females, p < 0.0001); only in females was this prevalence higher in injured drivers than in patients (p < 0.05). Opiates were present in 10.5% of drivers' and 10.4% of patients' urine samples (NS), and were more frequent in urine samples positive for cannabinoids, in drivers (p < 0.01) as well as in patients (p < 0.001). The prevalence of cocaine metabolites in drivers and patients was 1.0 and 1.1% and that of amphetamines 1.4 and 2.5%, respectively. No causal relationship between drugs and accidents should be inferred from this retrospective study. Nevertheless, the high prevalence of cannabis and opiate (licit or illicit) use in young people, whether injured drivers or patients, has potential implications for road traffic safety in France. Cocaine and amphetamines did not appear to be a major problem, unlike the experience in other countries.

[Consequences for labile blood products of leukocyte depletion by whole blood filtration using the Leucoflex LST1 in-line filter. Evaluation of the Leucoflex LST1 filter]. / Conséquences sur les PSL de la déleucocytation par filtration du sang total avec le filtre intégré Leucoflex LST1. Evaluation du filtre Leucoflex LST1.

The aim of this study is to evaluate the effects of whole blood filtration after a storage time of 20-24 hours at laboratory temperature using the in line filter Leucoflex LST1. The study concerns 49 blood donations in which we studied leukocyte depletion, proteins (IgG, IgA, IgM, haptoglobin, C3, C4), coagulation factors (fibrinogen, factors XII, XI, IX, VIII, V, proteins S and C, plasminogen, tPA, D-Dimers, PDF) at day 1, the parameters of conservation (ATP, 2-3 DPG, extra cellular potassium, haemolysis, pH) of red blood cell concentrates (RCCs) and bacteriological sterility at day 1 and 42. Despite a correct leukocyte depletion (mean depletion of 3.96 log), a 10 fold higher mean level of residual leukocytes/unit than with buffy coat poor RCC filtration (0.514.10(6) vs 0.051.10(6)) is observed. Moreover a lot of concentrates are not in accordance with French regulations (7/42 with more than 1.10(6) leukocytes/unit). The variation of the rates of IgG, IgA, IgM, haptoglobin, C4 and protein C is not significant. For the others there is a slight decrease with a mean level remaining in a physiological range. No sign of activation is noted. The sterility assays remain negative and the RCC conservation is not altered. In conclusion, even if the quality of the leukocyte depletion is not satisfactory in our study and has to be stated more precisely by multicenter studies, the whole blood filtration does not alter the quality of the derived components and allows us obtain RCC in a bigger volume and containing more haemoglobin than with the classical procedure after removing the buffy-coat [10].

[Modification of hemorheological parameters in microvascular complications of diabetes]. / Modification des paramètres hemorhéologiques au cours des complications microangiopathiques du diabète.

The aim of the present study was to assess the possible modifications in the parameters of red cell aggregation and blood and plasma viscosity in 92 diabetic patients compared to 82 non diabetic control subjects. Based on the presence of microalbuminuria (> 30 mg/24 h) and/or retinopathy each group of diabetic patients was divided into two subgroups. This study shows increased red cell aggregation and blood viscosity among diabetic patients with microangiopathy. There was a very good correlation between fibrinogen level and the different rheological measurements. The results of this study confirm the importance of the blood rheology abnormalities observable in diabetes. These disorders increase peripheral vascular resistances and ischemia and therefore worsen diabetic nephropathy and retinopathy.