[Accidental injection sodium hypochlorite during endodontic therapy. Better understand to better manage]. / Injection accidentelle d'hypochlorite de sodium au cours d'un traitement endodontique. Mieux comprendre pour mieux gérer.

The high frequency of iatrogenic incidents during endodontic treatment is a source of stress for the practitioner. These incidents may occur during the different steps of a root canal treatment. During irrigation, extrusion of sodium hypochlorite beyond the apex is a rare but impressive accident. Sodium hypochlorite, is the most common irrigant used in modern endodontics, but when it comes in contact with the periapical tissue, it can cause complications ranging from mild discomfort to serious tissue damage such as the hematoma and hemato-emphysema. The aims of this article are to discuss through the presentation of two clinical cases: Etiological and predisposing factors; Signs guiding to suspicion of accidental injection of sodium hypochlorite. In this work, we focused on clinical keys that help the practitioner in better understanding this accident in order to prevent it or to manage it well when it occurs.

Immunohistochemical evaluation of two antibodies against PD-L1 and prognostic significance of PD-L1 expression in epithelioid peritoneal malignant mesothelioma: A RENAPE study.

BACKGROUND: Epithelioid peritoneal malignant mesothelioma (EPMM) is the most common subtype of this aggressive tumor. We compared two antibodies against PD-L1, a recent theranostic biomarker, and evaluated the prognostic value of PD-L1 expression by mesothelial and immune cells in EPMM. METHODS: Immunohistochemistry was performed on 45 EPMM. Clinical and pathological data were extracted from the RENAPE database. Using E1L3N and SP142 clones, inter-observer agreement, PD-L1 expression by mesothelial and immune cells and inter-antibody agreement were evaluated. The prognostic relevance of PD-L1 expression was evaluated in 39 EPMM by univariate and multivariate analysis of overall survival (OS) and progression-free survival (PFS). RESULTS: Inter-observer agreement on E1L3N immunostaining was moderate for mesothelial and immune cells, and fair for mesothelial and poor for immune cells using SP142. Using E1L3N, 31.1% of mesothelial and 15.6% of immune cells expressed PD-L1, and 22.2% of mesothelial and 26.7% of immune cells using SP142. Inter-antibody agreement was moderate. In most positive cases, 1-5% of tumor cells were positive. Using E1L3N, PD-L1 expression by lymphocytes was associated with better OS and PFS by both univariate and multivariate analysis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments. Solid subtype was an independent prognostic factor for worse OS. CONCLUSION: E1L3N appeared easier to use than SP142 to evaluate PD-L1 expression. A minority of EPMM expressed PD-L1, and only a few cells were positive. PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM.

[Cervical node fine needle aspiration: factors influencing the failure rate]. / Cytoponction ganglionnaire cervicale : facteurs influençant le taux d'échec.

INTRODUCTION: We had for aim to study the factors influencing the rate of non satisfactory (NS) cervical node fine needle aspirations (CNFNA). MATERIALS AND METHODS: We prospectively included 272 CNFNA, performed over 2 years (2010-2012). NS results were studied according to the following criteria: age, size and location of the node, number of punctures performed, and the operating physician's experience. RESULTS: Fifty-six (20.6%) of the 272 CNFNA were NS because they were acellular or paucicellular. The rate of NS CNFNA was not correlated with the patient's age: 63.6% for small lymph nodes (≤1 cm: P=0.01). Submandibular and jugulodigastric locations were observed in 28% of NS CNFNA and in 5% of satisfactory ones (P=0.001). The rate of NS CNFNA was 67% if 1 or 2 punctures were performed; it decreased to 18% for 3 or more punctures (P=0.01). This rate was 77% for the first study semester, and 8% for the fourth semester (P=0.001). CNFNA has been repeated for 19 patients. The second CNFNA was contributive for 14 patients. Repeating the CNFNA increased its efficiency by 73.7% (14/19). DISCUSSION: The rate of NS CNFNA depends on the size and location of the lymph node, and the operating physician's experience. Repeating the CNFNA significantly improves its efficiency.