[Action of SERM and SAS (tibolone) on breast tissue]. / Action des "SERM", "SAS" (Tibolone) sur le tissu mammaire.

SERMs are developed in HRT in order to provide the beneficial effects of estradiol on bone and the cardiovascular system. SERMs are antiestrogens and their properties depend upon the pharmacological class they belong to. Tibolone is a progestin with mixed properties. Our studies on breast cells in vitro demonstrated that it behaves as a progestin in these cells. The clinical data obtained with these various therapies on breast are presented.

[Hypomagnesemic and hypocalcemic coma, convulsions and ocular motility disorders after chemotherapy with platinum compounds]. / Coma, crise convulsive et troubles de l'oculomotricité hypomagnésémiques et hypocalcémiques après chimiothérapie par sels de platine.

We describe a case of neurologic manifestations including coma, convulsion and eye movement disorders, associated with hypomagnesemia and hypocalcemia in a patient treated with cisplatin for an ovarian adenocarcinoma. Pathophysiological mechanisms involve renal tubular damage leading to renal magnesium wasting and related hypocalcemia.

[Treatment using concomitant radiochemotherapy of N+ M0 stage urothelial tumors of the bladder]. / Traitement par radiochimiothérapie concomitante des tumeurs urothéliales de vessie N+ M0.

Seventeen patients with N+ urothelial bladder tumours were treated by a combination of deep endoscopic resection and concomitant radiochemotherapy (5FU cisplatin). 15 patients completed their course of treatment. 52.9% of these 17 patients are in complete remission at 6 months, 35.2% are in complete remission at 1 year, 30% of patients in complete remission developed distant metastases, 52.9% developed local progression and 40% developed distant metastases. This protocol of deep resection combined with radiochemotherapy can therefore be effective in the local control of the tumour and can allow preservation of the bladder in the case of complete remission. However, it is insufficient to prevent the development of distant metastases. It is therefore preferable to intensify this treatment by performing complete endoscopic resection, by increasing the radiotherapy dose rate and by intensifying the chemotherapy protocol.

Bcl-2 expression in normal endometrium during the menstrual cycle.

Bcl-2 is a proto-oncogene initially described in the (14;18) translocation in follicular lymphoma. It has been shown to prolong cell survival by preventing apoptosis. Endometrium undergoes rapid proliferation and differentiation under hormone control and is thus an excellent model to study the hormone dependency of Bcl-2 expression. We studied Bcl-2 expression by an immunohistochemical method in 53 samples of normal endometrium randomly distributed throughout the menstrual cycle, as well as five samples of hyperplastic endometrium. Bcl-2 staining predominated in glandular cells and peaked at the end of the follicular phase. Bcl-2 expression disappeared at the onset of secretory activity. The stroma, surface lining epithelium and arterial vessels also displayed cyclic variations in Bcl-2 expression. These results strongly suggest hormone-dependent regulation of Bcl-2 expression, which could play an important role in tumorigenesis.

[The role of calcium at different ages in women's life]. / Place du calcium aux différents âges de la vie des femmes.

The present long life of women raises the problem of prevention against osteoporosis. Bone mass formation during adolescence is the first critical period, and it might condition the future bone mineral content. Eighty percent of the bone mass is of genetic origin, whereas 20 percent depends on the environment (diet, hormones, etc.). Menstrual disorders may be responsible for bone mineral loss. Pregnancy and breast-feeding are periods in which calcium requirements increase, yet in all but high risk women there are seldom responsible for osteopoenia. The first 10 years of menopause constitute a period of exponential bone mineral loss, and this is when oestrogen therapy is most effective against bone loss. The usefulness of calcium is still a matter of debate, with conflicting results concerning its preventive action on osteoporosis. There seems to be a threshold phenomenon: when normal diet provides a small amount of calcium, calcium supplementation is effective, but beyond a certain level supplementation is thought to be useless. The results found in the literature are presented, and the amounts of calcium intakes recommended at different ages are given.

Primary non Hodgkin's malignant lymphoma of the vagina. Report of 3 cases with review of the literature.

Twenty cases of primary non-Hodgkin's malignant lymphoma (ML) of the vagina were studied: the 17 cases reported in the literature, and 3 further cases observed at the Hôtel-Dieu Hospital in Paris over the last 10 years. The mean age of the women was 49 years. The most frequent complaint was vaginal bleeding, only a few patients presented an ulcerated mass. No evidence of ML was seen on any of the cervico-vaginal cytologic smears. Diagnosis was made on the vaginal biopsy. According to the Kiel classification, 8 of these ML were of low malignancy and 12 of high malignancy. Apart from one of our cases, which was an angiocentric pleomorphic T ML with predominance of medium-sized cells, they were all B ML. According to the Ann Arbor staging system for extra-nodal ML, 12 of these ML were stage IE, 2 were stage IIE and 2 other stage IVE. Eight patients died, 6 of ML less than 17 months after diagnosis, 2 much later of diseases unrelated to ML. The mean follow-up period of patients who survived, free of disease, was 75 months. The surgical treatment has to be limited, associated with polychemotherapy and completed by local radiotherapy.

Epithelial tumors of the ovary: comparison of MR and CT findings.

Forty patients with 50 ovarian epithelial tumors of the ovary were retrospectively studied. They underwent computed tomography and magnetic resonance (MR) imaging within 1 week of surgery. MR examinations were performed with a superconducting magnet (0.5 T) and predominantly T1- and T2-weighted MR imaging. T1-weighted MR images were obtained in eight patients after contrast material was administered. Signal intensity of tumors was compared with that of urine, muscle, and fat. Morphologic features that were evaluated included size, vegetations, septations, wall thickness, fluid or solid components, and vascularity. On the basis of signal intensity and morphologic characteristics, MR imaging helped in the correct diagnosis of benign serous cystadenoma in 10 of 13 tumors, benign mucinous cystadenoma in seven of 10 tumors, and tumors of low malignant potential and malignant tumors in 23 of 27 tumors. Accuracy for overall characterization of benign versus malignant tumors was 86% with MR imaging and 92% with computed tomography. There was no difference in sensitivity (P = 1) or specificity (P = .5).

Catalase-associated abnormalities and H2O2 increase in pre-neoplastic and neoplastic lesions of the human lower female genital tract and their near adjacent epithelia.

We report that an internal and non-UV-dependent type of neoplasia, the human cervical intraepithelial neoplasia (SIL), is also deficient in catalase activity, like the UV-induced tumors in the autosomal recessive human epithelial disease, xeroderma pigmentosum (XP). Whether or not the lesions are papillomavirus (HPV) positive in the different categories of preneoplastic and neoplastic extracts, the following parameters are affected: i), catalase activity level; ii), kinetic profile of catalase activity; iii), H2O2 increase. Mathematical treatment of these parameters (CONSTEL-Program), unambiguously distinguishes between normal and pathological cases. Such analyses make it possible to grade the pathological samples into 4 classes, depending on their deviance from normality. These classes may be correlated with the gradual steps in the process of malignant transformation defined by histological and clinical diagnosis. We found conformity between catalase activity and histological analyses in 66 biopsies, out of a total of 100 biopsies (35 patients). Moreover, 23 patients presenting decreased catalase activities in 31 biopsies showed disease progression after 3 to 6 months contrary to surgery histological data. We show that ATP synthesis in the presence of catalase and H2O2 (further aspect of catalase function), may occur in neoplastic extracts at much lower concentrations of H2O2 than in normal extracts. Thus, the catalase abnormality seems to be a good tool to study pre-neoplastic to neoplastic evolution of lesions and their adjacent tissues of the lower female genital tract; furthermore, i) it provides an earlier, more powerful means of detecting micro-SIL in progression to squamous cell carcinoma, than combined clinical and histological examinations; ii) model for investigating drugs such as in situ H2O2 scavengers or agents increasing glutathione peroxidase activity (GSH).

Stimulated production of ATP by H2O2 disproportionation in extracts from normal and xeroderma pigmentosum skins, and from normal, xeroderma pigmentosum, ataxia telangiectasia and simian virus 40 transformed cell lines.

It has been previously shown that xeroderma pigmentosum (XP) skin biopsies and their established cell lines exhibit a decrease in catalase activity and enhanced formation of photo-produced H2O2. Several in vivo and in vitro thermodynamic results suggest that the energy of H2O2 disproportionation produced by catalase could be sufficient to synthesize ATP with or without the help of intact mitochondria. In this paper, we first studied the properties of H2O2-stimulated ATP production in extracts of normal and pathological XP skin biopsies and cell lines. In acellular extracts of normal skin biopsies and/or cell lines, ATP production can be increased 2- to 3-fold, but only with a narrow range of H2O2 concentration. In contrast, in extracts of pathological skins or cells, ATP production was only observed when using 10- to 1000-fold less H2O2 concentration as defined for normal extracts. Similar results were noted with two cell lines derived from patients afflicted with ataxia telangiectasia (AT), and with simian virus 40 (SV40) transformed lines of normal, XP and AT cells, Although we have no proof that such a process may exist in vivo, we would like to suggest that both H2O2-stimulated ATP production and catalase activity are good indicators of the degree of normality or abnormality of skin biopsies and/or cell lines.

[Prevalence of toxoplasmosis in a Sahelian zone]. / Approche de la prévalence toxoplasmique dans une zone sahélienne.

Screening for anti-toxoplasma antibodies by a hemagglutination test associated with direct agglutination tests, IF and ELISA, was carried out on 229 women (pregnant or not) attending the outpatient maternity clinic at Akokan (Niger). The global percent of premunition is 3.9 p.c. No evolutive toxoplasmosis was detected.

Peritoneal implants from ovarian tumors: CT findings.

Metastatic peritoneal implants were assessed preoperatively with computed tomography (CT) in 38 patients with ovarian tumors. In the 106 biopsy specimens of gross peritoneal implants and the 118 random biopsy specimens obtained from these patients, metastatic deposits were detected in 27 of 38 (71%) patients and in 104 biopsy sites. CT depicted metastatic lesions in 17 of 27 (63%) patients and in 63 of 104 (61%) biopsy sites. The three sites most commonly involved were the right subphrenic region, the greater omentum, and the pouch of Douglas. The usefulness of CT in detecting lesions depended mainly on the location of the implant and the presence of adjacent ascites, rather than on lesion size.

[A focus of kala-azar in Aïr (Niger): first confirmed autochthonous Nigerian case]. / Un foyer de kala-azar dans l'Aïr (Niger): premier cas nigerien autochtone confirmé.

From 9 cases personally observed by the authors, of which the first Nigerian case confirmed by the presence of Leishmaniae on a smear of medulla, a focus of Kala-Azar has been revealed.

Deficiency in the catalase activity of xeroderma pigmentosum cell and simian virus 40-transformed human cell extracts.

It has been previously shown that skin biopsies isolated from various xeroderma pigmentosum (XP) patients present a permanent decline in catalase activity from the onset of the disease to the tumor formation. We report here that cultured XP cell strains are also markedly deficient in the catalase activity with about only 25% of the activity measured in normal human cells. No direct correlation between catalatic activity and excision repair ability has been found, since a XP variant line is as deficient as an XP-C strain. The exact cause of the catalase deficiency is still unknown but could be due to the synthesis of a modified enzyme or to an abnormal regulation leading to a limited enzyme synthesis. Furthermore, simian virus 40 transformation of normal and radiosensitive cells (XP, ataxia telangiectasia) provokes a decrease in catalase activity of about 80% compared to the control derivatives. Mathematical analysis performed on our data shows a clearcut distinction between XP and normal cells while some of the XP heterozygote cells exhibit an intermediate behavior. Although most of the XP syndrome could be explained by the impairment in the excision repair ability, the decrease in catalase activity leading to a probable increase in intracellular H2O2 concentration and/or to a higher sensitivity to any oxygen-activated species could represent an additive effect in inducing the carcinogenic process.

Treatment of epidermoid anal canal cancer.

Between 1968 and 1979, 183 patients with invasive epidermoid cancer of the anal canal were treated at Institut Curie. There was 156 women, 27 men with a mean age of 67 +/- 11 years (range 40 to 85 years). The initial height of the tumor was less than 4 cm (65 patients), 4 to 6 cm (98 patients), and more than 6 cm (20 patients). All the patients received radiotherapy, either preoperatively or as curative procedure. Twenty-five patients received preoperative radiotherapy, and there was no residual tumor in 9 biopsies obtained at operation. Four local recurrences were observed. One hundred fifty-eight patients received curative radiotherapy, 115 of whom did not undergo operation. Eighty were alive with no evidence of disease and good anal function with a minimum of 3 years follow-up. We observed 15 local recurrences, 4 inguinal recurrences, and 8 visceral metastases. In addition, eight patients initially had such a big tumor that radiotherapy was only a palliative procedure. Forty-three patients required a surgical procedure after this curative radiotherapy. Colostomy (12 patients) or abdominoperineal amputation (25 patients) was required for local recurrence and colostomy was required for necrosis related to radiotherapy. Five year survival was 59 percent. The survival was related to the size of the tumor (p less than 0.0001). The likelihood of retaining normal anal function with local control of the tumor was also closely related to the initial size of the tumor.

[Xeroderma pigmentosum: development of photoformation of hydrogen peroxide and catalytic activity in skin cells; application to an early diagnosis and to a tentative treatment]. / Xeroderma pigmentosum: évolution de la photoformation d'eau oxygénée et de l'activité catalatique dans les cellules de la peau; application à un diagnostic précoce et à une tentative de traitement.

In Xeroderma pigmentosum (XP) a genetic-recessive ultraviolette-hypersensitive disease we found an accumulation of photoproduced H2O2 in skin cells accompanied by a breakdown of the catalatic activity. Both disorders intensified as the disease progressed. Concomitantly with these processes, one electrochemical peak of urine decreases. By the time epitheliomas appeared, this peak was no longer detectable. Several applications to the skin of a cream containing catalase seemed to prevent the formation and the evolution of neoplastic tumors during the treatment.

[Treatment of primary lesions in cancer of the mobile portion of the tongue. Experience of the Curie Institute (1959-1972)]. / Traitement de la lésion primaire dans les cancers de la langue mobile. Expérience de l'institut Curie (1959-1972).

Six hundred and two patients were treated for carcinomas of the mobile portion of the tongue between 1959 and 1972. 16% were classified T1; 48% were classified T2; 36% were classified T3. 64% had no clinical signs of lymph node spread (NO). In the majority of cases the treatment of the primary lesion consisted of radium implantation, either alone or in association with external radiotherapy. Lymph nodes were treated chiefly by surgery. The absolute and determined survival at 5 years was 36% and 48%. Determined survival for lesions classified T1, T2 and T3 was respectively 80%, 56% and 25%. 70% of recurrences occurred during the first year. 13% of the patients who developed a tumour recurrence are living at 5 years. 33% of patients undergoing secondary surgery for recurrence were living at 5 years. 2% of patients developed necroses which were treated surgically.

Experience of the Curie Institute in treatment of cancer of the mobile tongue: I. Treatment policies and result.

Six-hundred-two patients were treated for cancer of the mobile tongue between 1959 and 1972. Sixteen percent had T1, 48% T2, and 36% T3 lesions. Sixty-four percent had no palpable nodes (N0). The primary was treated in the majority of patients by radium implant alone or in association with external radiotherapy. Nodes were treated primarily by surgery. Absolute and determinate survivals at five years are 36% and 48%. Determinate survivals for T1, T2 and T3 tumors are 80%, 56%, and 25%. Fifty-nine percent of those with clinically negative neck nodes survived five years. Recurrence at the primary site alone or associated with neck failure is 14% for T1, 22% for T2 and 29% for T3. Seventy percent of recurrences occurred within one year. Although 13% of patients who had recurrences at the primary site were alive at five years, 33% of those who had salvage surgery were rescued. Two percent of patients required surgery for radiation necrosis. In our opinion, radiotherapy remains the treatment of choice for the management of the primary lesion of cancer of the mobile tongue.