[Reirradiation of head and neck cancers]. / Réirradiation des carcinomes de la tête et du cou.

Locally advanced head and neck cancers are primarily treated by a multimodal approach, including a combination of surgery, radiotherapy and chemotherapy. However, local relapse rate in a previously irradiated area remains high. Reirradiation for a nonoperable recurrence or a new primary tumour is now a therapeutic option thanks to technical progresses. This review presents results of published series in terms of toxicity and tumour response. All the publications are heterogeneous (population, dose, fractionation, concomitant chemotherapy or targeted therapy) and it is thus difficult to compare results. Reirradiation is feasible and appears less toxic with new techniques such as image guided radiotherapy (IMRT) or stereotactic radiotherapy, which could offer precise radiation delivery while sparing healthy tissues. Concomitant chemotherapy or targeted therapy may improve local control. Prospective evaluation of tumour response and complications is necessary.

Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases.

BACKGROUND: Infiltrating MBC represents less than 1% of all male cancers. Our study details clinico-pathological features, treatments and prognostic factors in a large French cohort. MATERIAL AND METHODS: Four hundred and eighty-nine patients were collected from 1990 to 2005. Median age was 66 years (34% over 70 years) and median follow-up 58 months. RESULTS: According to TN classification, we found T(1): 39%, T(2): 41%, T(3)T(4): 9%, T(x): 11% and N(1)N(2): 27%. Lumpectomy (L) and mastectomy (M) were performed in 8.6% and 91.4% of the cases. Axillary dissection (AD), sentinel node biopsy or both were performed in 90%, 2% and 5% of the cases, respectively. Ninety-five percent of tumours were ductal carcinomas; 47% were pT(1), 20% pT(2) and 33% pT(3)-T(4). Axillary nodal involvement was present in 52.8% cases. ER and PgR were positive in 92% and 89% cases. Radiotherapy (RT) was performed in 85% of the patients. Hormonal treatment (HT) was delivered in 72% of the cases. Tamoxifen and aromatase inhibitors were used in 85% and 12% of the cases; 34% of the patients received chemotherapy (CT). Local recurrence (LR), nodal recurrences (NR) and metastases occurred in 2%, 5% and 22% of the cases; 2% and 10% developed contralateral BC and second cancer. The 5- and 10-year overall survival (OS) rates were 81% and 59%; disease-specific survivals (DSS) were 89% and 72%. Death causes were BC 56%, second cancer 8%, complications 3%, intercurrent disease 15% and unknown 18%. In a univariate analysis, metastatic risk factors were T stage (T1: 19%, T(2): 26%, T(3)T(4): 40%; p=0.013), pN status (pN(0): 12% pN(1-3): 26% pN(>3): 44%; p<0.0001) and presence of locoregional recurrence (62% versus 18% p<0.0001). In a multivariate analysis, axillary nodal involvement and high SBR remain prognostic factors. CONCLUSION: Earlier diagnosis and wide use of adjuvant treatments (RT/HT/CT) widely decreased LR and increased survival rates in MBC, reaching female ones. Prognostic factors were also very similar to female ones.

[Male breast cancer: a review]. / Cancer du sein chez l'homme: revue de la littérature.

Male breast cancer (MBC) is considered as a rare disease comprising about 1% of all breast cancers. As compared to women breast cancer, MBC has some similarities and also some particularities related to age, comorbidities, breast volume, diagnostic delay, prognosis and survival. Modified radical mastectomy (MRM) with axillary dissection is the gold standard. Sentinel lymph node dissection is a promising option for early stages. Adjuvant radiation is proposed because of the high frequency of node involvement and central tumor location. In hormone receptor positive tumors tamoxifen remains the gold standard endocrine therapy because of the lack of data on aromatase inhibitors. Adjuvant chemotherapy can be proposed to high-risk patients while trastuzumab should be an option in breast cancer that overexpresses HER2. In the setting of considerable evolution in the management of women breast cancer, this review aimed to point out on the similarities and particularities of MBC and the future challenges to improve MBC outcome.

Docetaxel therapy for advanced hepatocellular carcinoma developed in healthy liver: report of three cases.

Systemic chemotherapy is generally ineffective in patients with advanced hepatocellular carcinoma (HCC). This could be partly explained by the frequent underlying cirrhosis, which induces serious toxicity requiring dose attenuation or drug discontinuation. We present observations of three patients with HCC developed in healthy liver and treated with docetaxel (100 mg/m(2) every 3 weeks in one patient; 30 mg/m(2) weekly, three times every 4 weeks in two patients). An objective partial response with long-term survival was obtained in all cases without severe toxicity. These results suggest that chemotherapy, and especially docetaxel, could be safe and effective in patients with HCC developed in healthy liver, and should be assessed in specific trials.

[Accelerated partial breast irradiation: a concept to individualize treatment in breast cancer]. / Irradiation partielle et accélérée du sein: un concept pour une individualisation thérapeutique dans le cancer du sein.

Whole breast irradiation delivering an equivalent dose of 50 Gy in 5 weeks, followed by a 10 to 16 Gy-boost to the tumor bed is the standard of care after breast-conserving surgery for early-breast cancer. Accelerated partial breast irradiation (APBI) is currently under investigations in large multi-institutional, prospective, randomized trials to objectively address the critical endpoints of treatment efficacy, toxicity and cosmesis. Patient's selection for this new approach is crucial to individualise treatments and define the subgroups of patients who will really benefit from APBI in terms of quality of life without decreasing long-term results of the disease control and cosmesis. In this review, we will discuss the patients' profiles selection for APBI regarding their general and tumor criteria. The differences between APBI techniques either performed intra or post operatively will be also discussed.

[Assessment of tumor radiosensitivity using functional and metabolic nuclear imaging in research and clinical practice. A review]. / Evaluation de la radiosensibilité tumorale par l'imagerie fonctionnelle et métabolique : de la recherche à l'application clinique. Revue de la littérature.

During the last half of century considerable research on radiosensitivity biomarkers has been published. However, to date there is no non-invasive marker of cellular radiosensitivity identified for clinical routinely use. In this review, the main functional and metabolic imaging isotopic techniques for tumor radiosensitivity that have been explored over the last years are being described. This indirect evaluation fall into 3 topics associated with tumor proliferation rate or apoptosis, tumor hypoxic fraction, neoangiogenesis and the intrinsic radiosensitivity of clonogenic tumor cells. The final objective of the radiosensitivity monitoring during radiotherapy would be to adapt treatment strategy for overcoming the identified radioresistance mechanism such as hypoxia by the addition of radiosensitisers for example. This would allow better tumor control rather than continue inefficient and costly treatment delivery, which in addition could compromise outcome.

[Acute myocardial infarction in myocardial bridge treated by coronary stent]. / Infarctus du myocarde aigu sur pont myocardique traité par l'implantation d'endoprothèses. Résultats immédiats et suivi à long terme.

The authors report the case of a symptomatic myocardial bridge treated in the acute phase of anterior wall myocardial infarction by classical stenting of the mid and distal left anterior descending artery. One and a half months later, intrastent restenosis at the two dilated sites, led to another angioplasty procedure with implantation of sirolimus-eluding stents. The outcome was good with no recurrence of angina at 16 months and control coronary angiography was totally normal at the 8th month.

VTAMN--a smart clothe for ambulatory remote monitoring of physiological parameters and activity.

The prototype of a communicating underclothe for medical remote monitoring was realized. It delivers physiological information on the subject (Cardiac Frequency, Breathing Frequency, surface and mid-temperature) as well as the environment and activity parameters (ambient temperature, fall detection). It also enables the automatic data transfer on event, with the localization of the subject.

Telemonitoring of vital parameters with newly designed biomedical clothing.

The paper describes the development of biomedical clothing for ambulatory telemonitoring of human vital parameters. VTAM (Vetement de Tele-Assistance Medicale) presents a T-shirt made from textile with woven wires and incorporating four smooth dry ECG electrodes, a breath rate sensor, a shock/fall detector and two temperature sensors. The garment is equipped for the signal pre-computing and transmission through a miniature GSM/GPRS module kept on a belt together with the power supply. Three VTAM prototypes have been tested on persons in a normal state of health using a medical protocol to assess the biomedical data that include an ECG reading, a pneumogram, temperature and fall detection in mobile situations.

HUMEX, a study on the survivability and adaptation of humans to long-duration exploratory missions, part I: lunar missions.

The European Space Agency has recently initiated a study of the human responses, limits and needs with regard to the stress environments of interplanetary and planetary missions. Emphasis has been laid on human health and performance care as well as advanced life support developments including bioregenerative life support systems and environmental monitoring. The overall study goals were as follows: (i) to define reference scenarios for a European participation in human exploration and to estimate their influence on the life sciences and life support requirements; (ii) for selected mission scenarios, to critically assess the limiting factors for human health, wellbeing, and performance and to recommend relevant countermeasures; (iii) for selected mission scenarios, to critically assess the potential of advanced life support developments and to propose a European strategy including terrestrial applications; (iv) to critically assess the feasibility of existing facilities and technologies on ground and in space as testbeds in preparation for human exploratory missions and to develop a test plan for ground and space campaigns; (v) to develop a roadmap for a future European strategy towards human exploratory missions, including preparatory activities and terrestrial applications and benefits. This paper covers the part of the HUMEX study dealing with lunar missions. A lunar base at the south pole where long-time sunlight and potential water ice deposits could be assumed was selected as the Moon reference scenario. The impact on human health, performance and well being has been investigated from the view point of the effects of microgravity (during space travel), reduced gravity (on the Moon) and abrupt gravity changes (during launch and landing), of the effects of cosmic radiation including solar particle events, of psychological issues as well as general health care. Countermeasures as well as necessary research using ground-based test beds and/or the International Space Station have been defined. Likewise advanced life support systems with a high degree of autonomy and regenerative capacity and synergy effects were considered where bioregenerative life support systems and biodiagnostic systems become essential. Finally, a European strategy leading to a potential European participation in future human exploratory missions has been recommended.

[Biochemical markers of myocardial damage after high-energy radiofrequency ablation of atrial flutter. Value of troponin I]. / Marqueurs biochimiques de souffrance myocardique après ablation du flutter auriculaire par radiofréquence de haute énergie. Intérêt de la troponine I.

Creatinine phosphokinase and its MB iso-enzyme do not allow assessment of the degree of tissue necrosis after radiofrequency ablation. Cardiac Troponin I and myoglobin, new markers of myocardial lesions, are rarely used in this indication. The aim of this prospective study was to measure and compare serum markers of myocardial damage after high energy radiofrequency ablation of atrial flutter with an 8 mm distal electrode catheter. The authors measured serum cardiac Troponin I, myoglobin, creatinine phosphokinase and its MB iso-enzyme levels before and 4, 12 and 24 hours after radiofrequency ablation of common atrial flutter in 23 consecutive patients. The same markers were also measured in a control group of 9 patients undergoing electrophysiological investigation without radiofrequency ablation. All ablation procedures were simple with an average of 12.6 +/- 6 applications of radiofrequency. Bidirectional isthmic block was obtained in 22 of the 23 patients. The mean Troponin I levels were 0.01 microgram/l before ablation, 0.87 +/- 0.77 at the 4th hour (p < 0.001 versus control), 1.16 +/- 1.2 at the 12th hour (p < 0.001 versus control) and 0.7 +/- 0.63 microgram/l at the 24th hour (p < 001 versus control) after ablation. Only 13% of patients had cardiac troponin levels greater than the threshold of significant myocardial damage (> 2 micrograms/l) with a higher average number of radiofrequency applications than the rest of the group: 15.2 +/- 1 versus 11.5 +/- 5.1 (p < 0.05). An abnormally high level of markers was found in the ablation group for 19 patients (84%) with Troponin I (> 0.4 microgram/l), for 10 patients (43%) with the MB iso-enzyme (> 8 Ul/L), and for 1 patient (4%) with myoglobin (> 90 micrograms/l), and in no patient for creatinine phosphokinase (> 290 IU/L). All values were normal in the control group. The authors conclude that cardiac Troponin I is the most sensitive marker for myocardial cellular damage after high energy radiofrequency ablation of atrial flutter. The level of cardiac Troponin I seems to correlate with the number of applications of radiofrequency.

[Antithrombotic treatment protocols in interventional cardiology]. / Mise au point des protocoles de traitement antithrombotique en cardiologie interventionnelle.

The use of coronary stents has become routine in interventional cardiology, for which anti-platelet drugs are part of the daily antithrombotic routine. The association of ticlopidine and aspirin may be replaced definitively by that of clopidogrel and aspirin. A rapid biological test of the efficacy of these thienopyridines would allow identification of possible drug resistance. The anti-GP IIb/IIIa agents with an immediate onset of action are also widely used in the acute phase of MI and in acute coronary syndromes without ST elevation when the troponin levels could enable selection of high risk patients more likely to benefit from an aggressive antithrombotic strategy. Finally, the superiority of enoxaparin over unfractionated heparin must be emphasised in these same acute coronary syndromes.

Unprotected left main coronary artery stenting: immediate and medium-term outcomes of 140 elective procedures.

OBJECTIVES: We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis. BACKGROUND: Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet regimens and their validation against restenosis, warrants a reappraisal of angioplasty in LMCA stenosis. METHODS: From January 1993 to September 1998, 140 consecutive unselected patients with unprotected LMCA stenosis underwent elective stenting. Group I included 47 high-CABG-risk patients, and group II included 93 low-CABG-risk patients. Ticlopidine without aspirin was routinely started at least 72 h before the procedure and continued for one month. Patients were reevaluated monthly. A follow-up angiography was requested after six months. RESULTS: The procedure success rate was 100%. One-month mortality was 9% (4/47) in group I and 0% in group II. A follow-up angiography was obtained in 82% of cases, and target lesion revascularization was required in 17.4%. One-year actuarial survival was 89% in the first 29 group I patients and 97.5% in the first 63 group II patients. CONCLUSIONS: Stenting of unprotected LMCA stenosis provided excellent immediate results, particularly in good CABG candidates. Medium-term results were good, with a restenosis rate of 23%, similar to that seen after stenting at other coronary sites. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PTCAs.

Coronary artery stenting without anticoagulation, aspirin, ultrasound guidance, or high balloon pressure: prospective study of 1,051 consecutive patients.

Between March 1994 and November 1995, 1,212 coronary stents were implanted in 1,051 consecutive patients at our institution with the following protocol: daily pre- and poststenting treatment with ticlopidine 500 mg without aspirin, implantation under angiographic guidance, without ultrasound, with semi-compliant balloons inflated at 10 bars. Stenting was indicated after failure of balloon angioplasty (bail-out, dissection, elastic recoil) in 27% of the patients and considered as elective (de novo, restenosis, chronic occlusion, saphenous vein grafts) in 73% of the cases. During the 30-day follow-up period, stent thrombosis occurred in 11 patients (1.0%) and vascular access-site complications in three patients (0.3%). Thirteen patients (1.1%) died, 10 from previous left ventricular failure, 3 (0.3%) from subacute thrombosis. Multivariate analysis revealed that the size of the last balloon used was associated with subacute stent thrombosis Thus, in nonselected patients, placement of coronary stents may be safely achieved without use of warfarin, post procedural heparin, high balloon pressure, or ultrasound guidance. Antiplatelet therapy with ticlopidine and angiographic guidance result in a stent thrombosis rate of 1% and a vascular complication rate of 0.3%.

Retrograde left main stenting.

Percutaneous transluminal coronary angioplasty of protected left main coronary artery stenosis is usually performed by an antegrade approach. In this case report, we describe left main coronary artery stenting by a retrograde approach through a saphenous venous graft in a patient in whom the antegrade approach was considered less appropriate due to chronic ostial occlusion.

ECG changes during the experimental human dive HYDRA 10 (71 atm/7,200 kPa).

Electrocardiogram (ECG) analysis was performed in three human divers during a 71 atm (7,200 kPa) saturation dive (COMEX HYDRA 10 experiment). The inhaled gas mixture was slightly hyperoxic; its composition was basically helium and oxygen. Hydrogen was introduced during compression and its partial pressure reached 20 atm. ECG changes were the same in the three divers. Marked bradycardia rapidly appeared at the beginning of compression, then this response adapted throughout the dive. P-R, QRS, and Q-T intervals and the S-T segment did not change significantly. The QRS axis remained stable. However, a rightward shift occurred in P and T vector angles. These changes were correlated with time and gas density, respectively. The modifications of ventricular repolarization during compression are similar to those we observed during the HYDRA 9 COMEX dive. They may correspond to changes in duration of myocardial cell repolarization due to increased intrathoracic pressure changes with dense-gas breathing. A marked global diminution of voltage occurred during the decompression period. This suggests that accumulation of micro bubbles in tissues may influence the impedance, causing an artifact in the amplitude of ECG complexes.

The chemical and mineralogical behaviour of Pb in shooting range soils from central Sweden.

Recently investigations have shown that the annual flux of lead from shotgun pellets to shooting range soils is significant in some countries. This paper presents the data of chemical and mineralogical analyses of soils and Pb-pellet crusts from five shooting ranges in Sweden and, based on these results, evaluates the retention of lead in these shooting range soils. In the soils, Pb-pellets and bullets are readily decomposed and transformed to crust materials composed of Pb-bearing minerals. The transformation products in the crust materials, identified by X-ray diffraction, are predominantly hydrocerussite [Pb(3)(CO(3))(2) (OH)(2)], associated with cerussite (PbCO(3)) and anglesite (PbSO(4)). In a period of 20-25 years, an average of 4.8% metallic lead in the pellets has been transformed to lead carbonate and lead sulphate, where the former is the more stable mineral in the surface environment. However, in soils relatively rich in humus an average of 15.6% metallic lead in the pellets was transformed to secondary lead compounds in the same period. The results of the chemical analyses indicate that Pb is rather immobile in the soil profile. The surficial horizon contains higher concentrations of lead (52-3400 mg kg(-1)), while lower concentrations of lead were found in the E and B horizons where the total Pb concentrations (8-37 mg kg(-1)) are within about one standard deviation of the mean reference sample concentration. An inverse relationship is revealed between the aluminium hydroxide content of the soil fraction and EDTA-extractable Pb, which suggests that these compounds have affected the retention of lead.

[Rotablator and endoprosthesis on the left main coronary trunk]. / Rotablator et endoprothèse sur tronc commun de la coronaire gauche.

A 78 year old woman with unstable angina due to significant stenosis of the left main coronary artery and occlusion of the right coronary artery was treated medically for 29 months because of a surgical contraindication. Resistance to drug therapy led to referral for complex angioplasty of the left main, left anterior descending and left circumflex arteries, successively by rotablator and balloon angioplasty. An immediate elastic recoil on the left main coronary artery led to implantation of a Palma-Schatz stent. There were no complications and the patient is asymptomatic twenty months later.

[Pilot study of the efficacy of ticlopidine in early patency of coronary endoprostheses]. / Etude pilote de l'efficacité de la ticlopidine dans la perméabilité précoce des endoprothèses coronaires.

Subacute thrombosis of coronary stents is the main complication of this technique. The authors studied the outcome of 387 patients and 400 coronary arteries who underwent implantation of 427 stents between December 1989 and February 1994 and followed up one month after the procedure: all patients receive 500 mg of ticlopidine daily from three days before angioplasty throughout the hospital period and continued for at least one month. Anticoagulation with heparin was undertaken by the intravenous route after implantation and relayed with subcutaneous heparin for one week until control coronary angiography performed in the first 300 patients. At one month, 96.9% of patients were free of clinical coronary events. The following major complications were observed: 5 deaths (1.3%), 5 Q wave myocardial infarctions (1.3%); no emergency bypass surgery. The peripheral vascular complication rate was 3.6%. Univariate analysis three risk factors of subacute thrombosis: age (p = 0.0058), arterial diameter of less than 3 mm (p < 0.01) and implantation for occlusive dissection (p = 0.03). Multivariate analysis showed two independent risk factors: age (p = 0.001) and arterial diameter of less than 3 mm (p = 0.01). This pilot study shows a particularly low subacute thrombosis rate in unselected indications with an acceptable level of vascular complications.