CD44 exon 6 expression as a possible early prognostic factor in primary node negative breast carcinoma.

Breast cancer is the most common female malignancy affecting approximately one woman in eight. Many attempts have been made to define markers which may have potential clinical applications in diagnosis as well as therapy. New isoforms of CD44 with alternative spliced exons have recently been described. We studied the expression of CD44 exon 6 using a semi-quantitative RT-PCR reaction on a panel of 25 normal breast specimens, 10 mammary fibroadenomas, eight cystic samples and 52 primary breast tumors. Significant correlation was found between CD44 exon 6 expression and the overall survival of the N-M-population, P = 0.032, (logrank test by Mantel's method). The same result was also observed for the disease-free survival, P = 0.000002 (logrank test by Mantel's method). CD44 exon 6 expression, as detected by our RT-PCR-based method, might be a useful prognostic indicator of metastasis in breast cancer. However, these preliminary results need to be confirmed by later retrospective and prospective studies on a larger number of patients.

Expression of CD44 spliced variants with both exons v9 and v10 in primary N(-)M(-) breast carcinomas correlates with metastasis.

We analyzed the representation of CD44 isoforms with both exons v9 and v10 among CD44 total amount and also examined correlation between their expression, clinical parameters and survival. We used a semi-quantitative RT-PCR reaction and a panel of 25 normal breast specimens, 10 mammary fibroadenomas, 8 cystic samples and 52 primary breast tumors. CD44 expression level was statistically higher in malignant tumors than in normal breast tissues (p = 0.038) or in fibroadenomas (p = 0.047) and correlated with histological grading, p = 0.047. Ratios CD44 variants with both exons v9 and v10/ total CD44 were similar in normal breast tissues and fibroadenomas but lower in the cystic samples. In primary N(-)M(-) breast tumors, unfavourable outcome and relapse were correlated with low ratios.

Are CD44 spliced variants involved in human breast cancer metastasis?

Expression of CD44 isoforms has been investigated on normal breasts, fibroadenomas, cysts and breast cancers. Carcinomas express additional variants in comparison with normal breasts while fibroadenomas and cysts do not. Invasive cancers also express more variants than in situ carcinomas. Recent studies tend to demonstrate that overexpression of CD44 is not a survival prognostic factor whereas expression of exon 2v and/or 3v could be. Results for exons 4v to 10v are presently conflicting. Further studies will then be necessary to clarify the role of CD44 isoforms in mammary carcinogenesis and metastasis. Metastatic capacity could be linked with expression of additional variants but also with no transcription of variants associating exon 6v with either exon 10v or both exons 9 and 10v.

Role of chemotherapy in acute breast cancer. Analysis of 41 cases.

Clinical and therapeutic results in a series of 41 patients treated for inflammatory cancer of the breast lend emphasis to the selection criteria to be included in a short (approximately two months) clinical history to complement Haagensen's criteria. Chemotherapy improved the previous very poor results obtained in this condition. Survival after surgery and radiotherapy were less than 5% at five years, and this is compared with the prognosis in the series study. However, these results are still only fair in absolute terms and there is still no currently available alternative solution to attempt to achieve a marked improvement in the course of the lesion.

[Covering of substantial loss of substance in breast cancer with local complications. Apropos of 57 cases]. / Couverture des grandes pertes de substance en cas de cancer du sein compliqué localement. A propos de 57 cas.

On the basis of 57 cases, the authors report their experience in the repair of substantial losses of tissue caused by surgical resection of local neoplastic recurrences of breast cancers, in particular those situated in irradiated zones, and in certain cases by surgical resection of locally developing and neglected neoplastic lesions. Three types of operation are practised and the techniques involved in these are reviewed: Omentoplasty according to Kiricuta (35 cases), Musculocutaneous flap of the latissimus dorsi muscle (10 cases), Cutaneous and cutaneo-glandular flaps (12 cases). The choice of technique is based on the local conditions and the evolutivity of the neoplastic disease. The results obtained at the local level are then analysed in function of the lesions treated (comparing in particular irradiated and non-irradiated zones), the area resected and the type of operation chosen. Such an analysis reveals that the pedicled omentum flap, owing to its high trophicity, its ease of mobilization and its large size, constitutes the most reliable and effective technique in the treatment of extensive radionecroses. Less substantial losses of tissue may benefit appreciably from the use of a latissimus dorsi musculocutaneous flap, characterized by easy mobilization and high vitality and providing a covering of quality at the cost of a relatively unobtrusive scar. The use of cutaneous flaps can be advocated only for small areas and should be avoided in irradiated zones.

Appendicular mucocele and peritoneal pseudo-myxoma. / Mucoeéle appendiculaire et pseudo-myxome péritonéal

From 2 personal cases the authors present a pathological appraisal of appendicular mucoceles. They distinguish between a benign kind with an atrophic mucous membrane and a malignant type with a hyperplasic epithelium arranged in papillary and vegetating structures; this is a neoplasm with local malignancy. This variety remains the most liable to become a peritoneal pseudo-myxoma representing the most serious complication of the appendicular mucecele. Treatment of the mucocele, which consists in an appenicectomy or a right bemi-colectomy, usually yields good results provided operative rupture can be avoided. Contrarily the peritoneal pseudo-myxoma remains a serious disease with a disappointing treatment.

[Agenesia of the gallbladder. Report of two new cases (author's transl)]. / L'agénésie de la vésicule biliaire. A propos de 2 nouvelles observations.

A propos 2 personal cases of a rare malformation, agenesia of the gallbladder, the authors reappraise the anomaly, of which the precise diagnosis is essentially surgical. They stress the frequency of associated malformation and the usefulness of operative exploration with cholangiography. There is no specific treatment for this condition. Draining the principle bile duct is warranted in case of choledocotomy.

[Nailing according to Ender. Biomechanical study and results of 120 cases]. / L'enclourage selon Ender. Etude biomécanique et résultats à propos de 120 cas

The authors have conducted a clinical and biomechanical study of blind nailing of trochanteric fractures by the Ender's technique. The nail is introduced through the medial femoral condyle. The study was based on 120 operations. From the biomechanical standpoint, the authors studied the forces exerted in the medullary canal of the femoral shaft and the grip of the nail in the head and neck of the femur. In most of the cases the technique allowed immediate walking with weight-bearing. The results are compared with those obtained after nail-plate fixation. They were superior on three counts--less infection, less breakage of inserted material and less non-union, but the technique produced more mal-union. For this reason, the authors consider it to be an excellent technique but to be reserved for older patients.

[Generalised fecal peritonitis. Etiopathogenic and therapeutic considerations in 30 cases (author's transl)]. / La péritonite stercorale généralisée. Considérations étiopathogéniques et thérapeutiques à propos de 30 cas.

The authors analyse a series of 30 cases of generalised fecal peritonitis which represents a less frequent form of peritoneal infection. The etiology was mainly diverticular perforation (50 p. cent) or neoplasia (25 p. cent). The mortality was high (63 p. cent). It seems, in the light of the results, that the best treatment consists of operating in two stages, the first being the eradication of the colonic lesion which should be carried out as a routine without attempting immediate anastomosis. Wide drainage with peritoneal lavage and the use of "noxythioline" may improve the results of a disease which always remains very severe.

[Surgery of complicated diverticular sigmoiditis. Report of 138 cases (author's transl)]. / Le traitement chirurgical des sigmoïdites diverticulaires compliquées. A propos de 138 observations.

The authors analyse a series of 138 cases of complicated diverticular sigmoiditis treated surgically. They noted 50% of pyostercoral peritonitis, 32% of persigmoid abscesses, 13% of case of intestinal obstruction, and 5% of cases of fistual or hemorrhage. The overall mortality was 28% and depended mainly more on the surgical management adopted than on the type of complication. In this respect, simple colostomy with drainage of the septic focus had a mortality of 18%. The results suggest surgical operation in two stages, in the form of colonic resection, with, depending on each case, an anastomosis straight away with transverse colostomy or segmental colectomy with bitubular colostomy (Mikulicz procedure) or, in rarer cases, simple colostomy. The authors emphasise the interest of early surgery in sigmoiditis with complications and contrast the mortality of cold surgery which is now about 5% compared with 28% in emergency cases with complications.

[The musculocutaneous flap of the latissimus dorsi in the treatment of recurrences of breast cancer]. / Le lambeau musculo-cutané du grand dorsal dans le traitement des récidives de cancer du sein.

Breast cancers local recurrence treatment usually requires a large chirurgical resection. Latissimus dorsi myocutaneous flap was used after mastectomy in 27 patients. This technique was performed in 14 patients who had a recurrence after exclusive radiotherapy treatment. The follow-up of all the patients was more than 5 years. A 42% survival rate has been quoted in this group, after a 11 years period. Latissimus dorsi myocutaneous flap seems to be a satisfactory alternative when performing reconstruction after wall excision under 300 cm2, excepted for recurrence of fast kinetic cancers.

[Immediate use of an expander during mastectomy. Analysis of 120 cases]. / L'utilisation immédiate d'un expanseur lors de la mammectomie. Analyse de 120 cas.

This study analyses a series of 116 patients, in whom mastectomy was followed by immediate insertion of temporary tissue expander. The technique is safe, simple and quick. It carries an acceptably low complication rate. Moreover, it does not interfere with any other local or general adjuvant therapy, if needed. The advantages are rapid post operative healing and psychological recovery, creation of a favorable site for a better quality breast reconstruction. Later on, any procedure for the breast reconstruction can be used. We concluded, that this procedure may be recommended more often; 62% of cases of mastectomies in this series.

[Treatment of breast cancer located behind the nipple with musculocutaneous flap from the latissimus dorsi. 1. Technical aspects]. / Traitement du cancer rétro-aréolaire du sein par lambeau musculo-cutané du grand dorsal. I) Aspects techniques.

The aim of this work is to present a conservative technique of breast retroareolar cancer. After whole excision of nipple areola area, reconstruction is immediately performed by transposition of a myocutaneous latissimus dorsi flap. After local radiotherapy, a new areola and nipple can then be made a few months later.

[Treatment of breast cancer located behind the nipple with musculocutaneous flap from the latissimus dorsi. 2) Analysis of a series of 14 cases]. / Traitement du cancer rétro-aréolaire du sein par lambeau musculo-cutané du grand dorsal. II) Analyse d'une série de 14 cas.

The authors report a series of 14 cases of retroareolar breast cancer treated by wide excision followed by reconstruction with latissimus dorsi flap. Based on clinical and histological datas, they establish surgical indications and show that this procedure can be used for central tumors whose diameter goes from 1.5 to 3 cm even if the nipple is retracted. Cosmetical and functional results are usually goods. They just have to note one infection medically treated.

[Anorexia: a redoubtable complication of the surgical treatment for obesity after jejuno ileal by-pass (author's transl)]. / L'anorexie: une complication sévère du traitement chirurgical de l'obésité par court-circuit jéjuno-iléal.

Three cases of severe anorexia are reported. It results in a strong protein malabsorption with hepatic steatosis and in a syndrome of mental depression which needed the re-establishment of the intestinal-continuity. Although a mild post-operative anorexia is regular and contributes to the weight loss, massive anorexia must be considered as a new and redoubtable unpredictible complication of the surgical treatment for obesity, which may hinder the intestinal adaptation and increase the protein malabsorption.

[Determination of plasmatic beta2-microglobulin in benign and cancerous diseases (author's transl)]. / Intérêt de la détermination de la beta2-microglobuline plasmatique dans diverses affections néoplasiques et bénignes.

The authors report on their experience of the beta2-microglobulin dosage in cancerous diseases and note an increase of its rate in 47% of the cases. A comparative study with certain benign diseases of the digestive tract shows that this dosage proves to be interesting.