[The virtual slide: a new tool for the External Quality Control for the spermatozoid assessment morphology]. / La lame virtuelle : un nouvel outil pour le contrôle externe de qualité de l'analyse morphologique des spermatozoïdes.

As part of the accreditation procedures, External Quality Control (EQC) must be performed for all biological determinations. In the exploration of male infertility, the spermocytogram is very important because it is often used as first line and an error of interpretation may have dramatic consequences. Alongside the EQC which usely consists of carrying out preparation slides (stained or not), we tested the use of a slide scanned from a stained specimen ("virtual slide"). All participants (n = 57) received a sample of the following supports: an unstained slide, a stained one and a virtual slide, all of them from a single human ejaculate. The required tests were the proportion of typical forms of spermatozoa and the degree of teratozoospermia using the Multiple Abnomalities Index (MAI) according to David's criteria. Results showed that for the two examinations, the dispersion of results remains similar regardless of the support. Furthermore, results seemed no to be influenced by the staining technique. This indicates that the discrepancy between results came from the quality of the observer. Moreover, the numerical values of half the participants were situated in the interval mean of ±â€Š30% for the evaluation of typical forms and ±â€Š15% for MAI. We recommend the virtual slide for EQC spermocytogram to evaluate and improve the reading ability. In addition, we propose to retain an interval of acceptability of ±â€Š30% for the evaluation of typical forms and ±â€Š15% for MAI.

Non-Hodgkin's lymphoma of the breast: a report of 19 cases and a review of the literature.

PURPOSE: Non-Hodgkin's lymphoma of the breast represents 0.04%-0.50% of malignant lesions of the mammary gland. In this article, we report a single institution's experience with this rare disease. MATERIALS AND METHODS: Between 1982 and 1997, 19 patients with breast lymphoma were diagnosed, treated, and followed at this institution. RESULTS: There were 18 female patients and 1 male patient. All but one were cases of aggressive B-cell lymphoma. Ann Arbor stages were IE (n=5), IIE (n=9), IIIE (n=2), and IV (n=3). International Prognosis Index scores were 0 (n=2), 1 (n=8), 2 (n=7), and 3 (n=2). According to the Wiseman and Liao classification established in 1972, 11 cases were primary lymphomas of the breast, and 8 cases were secondary involvement of the breast. Median survival time was 21.5 months (range, 5.1-114.7 months). The 5-year overall survival was 29%. Median event-free survival time was 8.3 months. The clinical, radiologic, and histologic patterns of presentation match previously published data, even if the response rates and the survival times seem disappointing, probably because of the initial treatment by tumorectomy or mastectomy for some patients. CONCLUSIONS: Systemic chemotherapy should be the mainstay of treatment. Based on our experience and a review of the literature, the use of Wiseman and Liao's classification is questionable. In fact, it fails to detect whether some lymphomas of the breast present a specific natural history and therefore require specific management. New clinical and histologic criteria are to be identified.

C-reactive protein to transthyretin ratio for the early diagnosis and follow-up of postoperative infection.

The clinical usefulness of C-reactive protein (CRP) and of transthyretin (TTR) for the early diagnosis and follow-up of infection after an open fracture was prospectively investigated (cohort A). It was complemented by a retrospective study of trauma patients admitted to an intensive care unit (cohort B). Serial determinations of serum CRP and TTR concentrations were first performed in uninfected patients from cohort A to define a reference profile during the early postoperative period. It showed a concomitant increase in CRP and decrease in TTR concentrations, followed by progressive return to initial values in patients free from bacterial infection. Variations of the CRP/TTR ratio were analyzed. Recovery phase was defined by an exponential evolution of the two plasma proteins and of their ratio value. The CRP and TTR concentrations were independent of sex and severity of the trauma. In the case of postoperative infection, patients of cohort A revealed amplified CRP and TTR responses usually preceding the occurrence of clinical signs. During successful antibiotic therapy, their recovery response became superimposable to that of the reference group. The same profiles were recorded in cohort B patients admitted with lower limb fractures or various types of trauma. This suggests that observations made on cohort A can be extrapolated to othertrauma patients. We recommend that serial measurements of CRP and TTR and of their ratio should be performed every 2 days to appropriately follow-up these patients.