Selection of an early biomarker for vascular normalization using dynamic contrast-enhanced ultrasonography to predict outcomes of metastatic patients treated with bevacizumab.

BACKGROUND: Dynamic contrast-enhanced ultrasonography (DCE-US) has been used for evaluation of tumor response to antiangiogenic treatments. The objective of this study was to assess the link between DCE-US data obtained during the first week of treatment and subsequent tumor progression. PATIENTS AND METHODS: Patients treated with antiangiogenic therapies were included in a multicentric prospective study from 2007 to 2010. DCE-US examinations were available at baseline and at day 7. For each examination, a 3 min perfusion curve was recorded just after injection of a contrast agent. Each perfusion curve was modeled with seven parameters. We analyzed the correlation between criteria measured up to day 7 on freedom from progression (FFP). The impact was assessed globally, according to tumor localization and to type of treatment. RESULTS: The median follow-up was 20 months. The mean transit time (MTT) evaluated at day 7 was the only criterion significantly associated with FFP (P = 0.002). The cut-off point maximizing the difference between FFP curves was 12 s. Patients with at least a 12 s MTT had a better FFP. The results according to tumor type were significantly heterogeneous: the impact of MTT on FFP was more marked for breast cancer (P = 0.004) and for colon cancer (P = 0.025) than for other tumor types. Similarly, the differences in FFP according to MTT at day 7 were marked (P = 0.004) in patients receiving bevacizumab. CONCLUSION: The MTT evaluated with DCE-US at day 7 is significantly correlated to FFP of patients treated with bevacizumab. This criterion might be linked to vascular normalization. AFSSAPS NO: 2007-A00399-44.

[Parathyroidectomy by elective route with perioperative measurement of parathyroid hormone. Report of 80 cases]. / Parathyroïdectomie par voie élective avec dosage peropératoire de la parathormone intacte. A propos de 80 cas.

STUDY AIM: The aim of this study was to report a series of 80 patients treated by unilateral neck exploration for a sporadic primary hyperparathyroidism. PATIENTS AND METHOD: Between April 1992 and November 1998, 80 patients (65 women and 15 men, mean age: 63.5 years) with a single gland enlargement localized by ultrasonography, were operated on through a short unilateral neck incision, under general anesthesia in 72 cases and local in eight cases. The enlarged gland was removed with intraoperative pathological examination and intraoperative monitoring of parathyroid hormone. RESULTS: Mean duration of surgery was 25 minutes. There was no postoperative mortality or morbidity. Mean duration of hospital stay was two days. The enlarged gland was an adenoma in 75 cases and an hyperplasia in five. Adequate intraoperative parathyroid hormone decrease was observed. Postoperative calcemia was normal in 78 patients (97.5%). Among 76 surviving patients, with a 31-month follow-up, there was only a suspicion of persistent hyperparathyroidism in two patients. CONCLUSIONS: Minimal invasive approach by unilateral neck exploration may be performed with safety and efficiency in patients with a single gland enlargement under intraoperative monitoring of parathyroid hormone.

[Metastatic epiduritis with invasiveness of the left renal vein]. / Epidurite métastatique avec envahissement de la veine rénale gauche.

We report a case of epidural metastasis with left renal vein invasion. This nonsymptomatic venous involvement was detected by ultrasonography and confirmed at CT and MR imaging. Such an unusual cause of renal vein tumor thrombus occurred through a lumbar vein which represents one of its usual collateral branches.

[Preoperative localization of parathyroid adenomas. Role of cervical ultrasonography]. / Localisation pré-opératoire des adénomes parathyroidiens. Place de l'échographie cervicale.

OBJECTIVES: We evaluated the sensitivity and specificity of cervical ultrasonography for the detection of primary parathyroid adenomas. METHODS: From January 1990 to May 1992, ultrasonography was performed before exploratory cervicotomy in 30 patients (10 males, 20 females, mean age 56.3 yr) whose diagnosis was primary hyperparathyroidism based on radioimmunoassay of parathyroid hormone. The same trained operator performed all the ultrasonographic examinations. RESULTS: Twenty-six parathyroid tumours were detected in 23 of the 30 patients examined by ultrasonography. The four standard localizations and one ectopic tumour were visualized. At surgery 37 tumours were found in 30 patients. Among the 11 false negatives, the operator had identified an abnormal tumour incorrectly as a cervical lymph node in 2. Most of the false negatives occurred early in the study. The sensitivity of ultrasonography was thus 70 % with a 100% specificity. CONCLUSIONS: Cervical ultrasonography is a reliable, non-invasive and relatively inexpensive examination which should be used as a first-line test for the aetiological assessment of hyperparathyroidism.

[Postmenopausal hydrometra. Influence of tamoxifen]. / L'hydromètre post-ménopausique. Influence du tamoxifène.

Vaginal ultrasonography of the uterus using a high frequency endocavitary probe was performed in 300 postmenopausal women: 150 receiving no replacement nor suppressive hormone therapy and 150 receiving adjuvant anti-estrogen treatment in the form of tamoxifen because of breast cancer. Evidence was found of hydrometra in 84 cases (28%): 10 in the group taking no hormone therapy (6.6%) as compared with 74 in the group exposed to tamoxifen (49.3%). The difference was statistically significant (p < 0.01). In addition, mean thickness of the endometrium was estimated at 6 mm (range: 2-40) in the first group versus 12 mm (range: 3-60) in the second (p < 0.001). It emerged from this comparative ultrasound study that the incidence of postmenopausal hydrometra was influenced by taking tamoxifen. Fluid secretion appearances seen one out of two in treated patients reflect the paradoxical proestrogenic type action of tamoxifen on the uterine mucosa.

[Breast hamartomas. Mammographic and histologic aspects. Apropos of 5 cases]. / Hamartomes mammaires. Aspects mammographiques et histologiques. A propos de 5 observations.

Five observations of hamartomas are reported, and compared with the data in the literature. We recall the principal radiological and histological aspects.