[Non-heart-beating renal donors: organization in a non-university hospital]. / Prélèvement rénal sur donneur décédé par arrêt cardiaque (DDAC): organisation dans un centre hospitalier non universitaire.

INTRODUCTION: In 2011 in France, all kidneys from patients with brain death and from living donors cannot meet the demand for renal transplants. Since 2006, sampling protocols kidneys from non-heart-beating donors (NHBD) are developed to increase the number of renal transplants. The objective was to describe the organization of a protocol NHBD in a non-university hospital. MATERIALS AND METHODS: Patients with inclusion criteria of protocol NHBD of the Agency of Biomedicine were prospectively included between 1st July 2011 and 31 December 2012. The protocol data were comparable to national data. Vascular canulation was performed by urologists. The epidemiological, clinical and biological characteristics of patients included, the different times and deadlines of the protocol, and data of renal transplantation were collected and analyzed. RESULTS: Over the period of 18 months, 16 patients were included in the protocol NHBD, with a median age of 42 years, and 87.5% of males; 93.8% of patients made a cardiac arrest outside the hospital. The median duration of no-flow was 4.3 minutes (0; 23), the median time between the cardiac arrest and admission to hospital was 90 minutes (0; 116), the median time between the cardiac arrest and the start of the normothermic recirculation was 139 minutes (40; 150), and the median duration of normothermic recirculation was 212 minutes (186; 240). For urologists, the median duration of mobilization was 178 minutes and 97 minutes after 20 h. Twenty-four kidneys were collected (75%) and 22 kidneys were transplanted (91.7%). The median duration of cold ischemia was 9 h 12 (5 h 25; 18 h 02). No primary non-function of graft was observed. Delayed graft function was observed in 50% of cases and the median duration of dialysis was 2 days (0; 19). After 12 months of inclusion, our center accounted for 8% of the national census and 16% of transplanted kidneys NHBD. CONCLUSION: The involvement of rescue, coordination, anesthesiologists and urologists, and the concentration of jobs in our center have helped to minimize response times NHBD in the protocol for maximum quality of kidneys taken with transplant rates and results are very encouraging.

[Contribution to the study of painful and functional sequellae after breast reconstruction using latissimus dorsi flap. Investigation into 149 patients]. / Contribution à l'étude des séquelles douloureuses et fonctionnelles après reconstruction mammaire utilisant le lambeau dorsal. Enquête auprès de 149 patientes.

Latissimus dorsi flap is the most commonly used among tissues transfers for breast reconstruction. If its qualities and performances are well known, few papers have studied sequellae of this flap, particularly painful. The purpose of this paper is to provide a contribution about this subject. Postulating the complexity of this step, we limited ourselves initially to an evaluation based on analysis of concise questionnaire mailed to two pools of patients with different delays since their reconstruction using latissimus flap. In the two groups of patients, announced principal embarrassment - logically associated with a gestural limitation - is the feeling of axillo-dorsal rigidity, more pregnant than the pain itself. This one is marked during the 2 to 4 first months in the majority of the patients (68 and 66 %), and can persist several years in some among them (14 %). These after-effects did not prevent almost all of the patients to take again their domestic and professional activities and to express a high level of satisfaction with respect to their reconstruction. The addition of a prospective series studying the postoperative pain after reconstruction with or without latissimus flap tends to confirm that any oncologic breast surgery, ablative or reconstructive, expose to painful sequellae more linked to individual factors than to the technique implemented.

[276 cases of horizontal infrahyoid myocutaneous flap]. / Le lambeau musculocutané infrahyoïdien à palette cutanée horizontale : à propos de 276 cas.

INTRODUCTION: The infrahyoid myocutaneous flap was described by Wang et al. in 1986. The horizontal design of the skin paddle is a modification of this technique allowing for a smaller scar. We have been systematically using this modified technique for 10 years. We had for aim to describe the interest of the horizontal infrahyoid myocutaneous flap for cervicofacial carcinology. PATIENTS AND METHODS: A horizontal infrahyoid myocutaneous flap procedure was performed in 276 cervicofacial carcinology patients for lesions of the mouth floor, the mandibular gum, the oropharynx and the tongue between March 1997 and March 2007. RESULTS: No complications were observed in 252 patients. No patient presented with total flap necrosis. DISCUSSION: Modifying the infrahyoid myocutaneous flap technique with a horizontal design of the skin paddle does not modify the reliability of the flap and prevents more extensive scars. The main indications of this technique are defects of the mouth floor, the tongue and the oropharynx.

[Optimize the resuscitation of prehospital cardiac arrest in trauma patients: a prospective register's experience]. / Optimiser la réanimation des arrêts cardiaques traumatiques préhospitaliers : l'expérience d'un registre prospectif.

OBJECTIVES: Describe the epidemiology and the survival of patients with traumatic cardiac arrest (CA), and compare them to those with nontraumatic CA. Highlight the weaknesses in their care and consider ways to improve their survival. METHOD: Traumatic and nontraumatic CA are described using the Utstein style in the "réseau nord-alpin des urgences" registry. Regarding the traumatic CA, we focus on circumstances, types of injuries and specific resuscitation techniques used. RESULTS: From 1st January 2004 to 31st December 2005, prehospital medical teams provided care to 1552 victims of CA, 129 of whom were trauma patients (8.3%). Average age was 47.1 years; 74.4% were males. Blunt trauma occurred in 94.6%. None of the patients had chest tube insertion or thoracotomy on the scene. A return of spontaneous circulation was observed in 24.8%, the survival after 24h was of 3.9%, and 0.8% of patients remained alive 1 year following the accident. The topography of lesions responsible for the CA as well as the fact that these lesions are limited or multiorgan influence the survival. CONCLUSION: The survival of patients with prehospital traumatic CA is catastrophic and it is worse than that of patients with nontraumatic CA. However, a specific earlier and more adapted prehospital resuscitation could help improve this survival.

[The horizontal infrahyoid myocutaneous flap: surgical technique]. / Le lambeau musculocutané infrahyoïdien à palette cutanée horizontale. Technique chirurgicale.

The infrahyoid myocutaneous flap technique was described by Wang in 1986, the skin pad being orientated vertically. Its blood supply comes from the superior thyroid artery. This flap consists of the sternohyoid muscle, the sternothyroid muscle, and the superior belly of the omohyoid muscle. The harvesting of a horizontal skin flap does not modify its reliability and avoids additional scars. The donor site anatomy and flap vascularization are briefly described as well as the flap features and harvesting technique.

[Primary intraosseous carcinoma of the jaws: results of treatment of 9 cases and proposed classification]. / Le carcinome intra-osseux primitif des maxillaires: à propos de 9 cas et proposition de classification.

INTRODUCTION: Primary intraosseous carcinoma of the jaws is a rare squamous cell carcinoma arising in the jaw, having no initial connection with the oral mucosa and presumably developing from residues of the odontogenic epithelium. OBJECTIVES: To present 9 cases and to propose a staging system of primary intraosseous carcinoma of the jaws. CASES AND METHODS: Careful assessment of the clinical, radiological and histological examination of the specimens identified 9 patients with primary intraosseous carcinoma of the jaws. RESULTS: The male/female ratio was 8/1 and the mean age of patients at the time of diagnosis was 61.7 years. All lesions were located in the mandible. Usually, clinical symptoms had benign aspect and delay the diagnosis. Radiographic features were unilocular osteolytic lesion and ill-defined margins were usually noted with a mean tumor size of 3.4 centimeters. The mean delay of the diagnosis was 4.9 months. Surgery at the tumor site consisted of hemi-mandibulectomy in all cases. All patients but one had neck dissection. The postoperative radiotherapy mean dose was 62.6 Gy. Histologically, most squamous cell carcinomas were well differentiated with keratinization. All lymph nodes metastasis had capsular involved. Complications occurred in 2 cases. Four patients had recurrences in the mean delay of 13.8 months. The estimated overall 2-and 5-years survival was 65% and 46.5% respectively. DISCUSSION: Primary intra-osseous carcinoma of the jaws is a rare tumor none classified by UICC with poor prognosis. We recommend an aggressive treatment with postoperative radiotherapy. We propose a computer tomographic classification: T1 (tumor strictly intra-osseous), T2 (tumor with cortical destruction without involvement of adjacent soft-tissues) and T3 (tumor involvement of adjacent soft-tissues).

Primary intraosseous carcinoma of the jaws.

OBJECTIVES: To present 8 new cases of primary intraosseous carcinoma of the jaws and to review the literature for an analysis of treatment modalities and patient outcomes. DATA SOURCES: A MEDLINE search from 1970 to 1999. The articles chosen and the study of the references of every one that produced additional articles provided database information for 28 patients. Eight new patients from our institutions were added. STUDY SELECTION: Our criteria of inclusion included the absence of ulceration of the oral mucosa, a negative result in the search for a distant primary tumor, and convincing histological documentation. DATA EXTRACTION: The variables of the analysis included age, sex, site of the tumor, condition of the oral mucosa, tumor size, neck status, treatment modalities, recurrences, and survival. DATA SYNTHESIS: Twenty-eight patients were identified in the literature, for a total of 36 patients. There were 28 males (78%) and 8 females (22%) ranging in age from 4 to 76 years (mean, 54 years). The tumor site was the mandible in 33 patients (92%) and the maxilla in 3 (8%). Of the 34 patients treated, 19 (56%) had recurrences. Overall 2- and 4-year survival was 60.5% and 39.9%, respectively. Patients who underwent radical surgery and postoperative radiotherapy (n = 11) had a 2- and 3-year survival probability of 61.3% and 40.9%, respectively, whereas in the remaining patients (n = 25), the rates were 59.7% and 31.3%, respectively (P =.60). CONCLUSIONS: Strict diagnostic criteria must be applied. The prognosis associated with primary intraosseous carcinoma of the jaws is poor and suggests the need for aggressive treatment.

Cyclofunctionalization and free-radical-based hydrogen-transfer reactions. An iterative reaction sequence applied to the synthesis of the C(7)-C(16) subunit of zincophorin.

The strategy considered herein features an iodocyclofunctionalization/hydrogen-transfer reaction sequence for the elaboration of propionate motifs. Proceeding with excellent yield and diastereoselectivity, the synthetic sequence proposed gives access to the anti-anti dipropionate motif when the reduction step is performed under the control of the exocyclic effect. The tandem sequence is applied successfully to the synthesis of the C(7)-C(16) subunit of zincophorin, and iteration of the process gives the desired anti-anti-anti-anti polypropionate stereopentad. Modifications of the reaction sequence--including phenylselenocyclofunctionalization, carbonate hydrolysis, and chelation-controlled radical reduction reactions--lead to the formation of the anti-syn dipropionate motif with remarkable diastereocontrol.

Dislocation of a plate-haptic silicone intraocular lens into the anterior chamber.

Posterior dislocation is a well-described complication of plate-haptic intraocular lenses (IOLs). It usually occurs after an opening in the posterior capsule, either intraoperatively or after a neodymium: YAG capsulotomy occurs. We report a case of anterior luxation of a plate-haptic silicone IOL occurring 4 months after uneventful cataract surgery. This case emphasizes the need for a small and continuous capsulorhexis as well as in-the-bag implantation of plate-haptic IOLs.

Analysis of 676 cases of ductal carcinoma in situ of the breast from 1971 to 1995: diagnosis and treatment--the experience of one institute.

Six hundred seventy-six patients with ductal carcinoma in situ of the breast (DCIS) from 1971 to 1995 were included in the study. Computerized patient files were retrospectively analyzed. Clinical findings were less frequently reported to reveal DCIS after 1989. Positive mammographic findings were obtained in 87% of patients and were mainly represented by microcalcifications (79.4%). Treatment procedures were breast-conserving surgery (BCS) alone (37.5%), BCS followed by radiation (BCSR) (25.5%), or mastectomy (M) (37%). The actuarial local recurrence was 2.6% in the M group (94 months of follow-up), 14.5% in the BCS group (85,7 months of follow-up), and 7.5% in the BCSR group (78.8 months of follow-up). Predictive factors of recurrence in all patients were invaded margin status and age. In the BCS group, grade was also a predictive factor. The analysis per decade shows that the lesions currently diagnosed are less serious than those of the past. All the recurrence in patients with positive margins was in the same quadrant as the original lesion. This further emphasizes the need for clear margins.

[Contribution to the study of the future of silicon-gel breast implants in mammary reconstruction after cancer: concerning 205 implants]. / Contribution à l'étude du devenir des implants mammaires siliconés en reconstruction mammaire après cancer: à propos de 205 implants.

Long term follow-up of 187 women with mammary reconstruction using 205 silicone-gel implants enables a retrospective analysis of the evolution of both patients and their prosthesis. Most patients have not presented local or general disease related to implant leakages. However, these leakages are not uncommon, being present in nearly one-third of 38 explantations motivated by aesthetic considerations (of which 50% are capsular retractions). All the ruptured or pre-ruptured implants are more than seven years old. Leakage frequency sharply increases after ten years. Authors tried to assess the place of radiologic evaluations (digitized costal profile, ultrasound, MRI...) in order to detect deterioration of the prosthesis. Although suspicions raised by these evaluations have made it possible to adequately target the explantations, pathogenicity of silicone-gel implants appears low enough to confirm the predominance of clinical follow-up.

Outcome of squamous cell carcinoma of the gingiva: a follow-up study of 83 cases.

BACKGROUND: Squamous cell carcinomas of the gingiva are relatively rare tumours. Standard treatment is based on surgery and radiotherapy. The extent of bone involvement affects mandibulectary indications. PURPOSE: A retrospective review of squamous cell carcinomas of the gingiva was performed to evaluate the incidence of mandibular or maxillary bone involvement. Indications for marginal and segmental bone resections are specified. MATERIAL: From 1985 to 1996, 83 patients with squamous cell carcinoma of the gingiva were treated at the Department of Surgery (Institut Bergonié, Bordeaux, France) and at the Department of Maxillofacial and Plastic Surgery (Centre Hospitalier Universitaire, Bordeaux, France). Forty-three underwent surgery plus postoperative radiotherapy. Twenty-two had flap reconstructions. Clinical evaluation and panorex roentgenography were the means used to evaluate bony invasion and to decide on the extent of bone resection. METHODS: A retrospective review of 83 consecutive patients was performed. This series is unusual in its homogeneity: surgery was performed by only two individuals and the radiotherapy was the responsibility of just two physicians. Outcome was calculated using the Kaplan-Meier method. RESULTS: Primary local control was achieved in 72 patients (87%). Overall survival and rate of recurrence were comparable to those of other squamous cell carcinomas of the oral cavity and oropharynx. CONCLUSION: Surgical resection continues to be the mainstay of treatment and this study tends to confirm the validity of modified neck dissection and marginal bone resection in suitably selected patients.

Supraomohyoid neck dissection in cancer of the oral cavity.

BACKGROUND: In oral cavity cancer, supraomohyoid neck dissection (SOHND) is becoming more popular for patients with N0 and N1 disease in the neck. The aim of this study was to assess the value of this surgical procedure. METHODS: The study included 237 previously untreated patients with oral cavity cancer. The neck treatment consisted of SOHND or functional neck dissection (FND). One hundred sixty patients underwent postoperative radiation therapy. Survival probabilities, neck recurrences, and distant metastases were analyzed according to the surgical procedure. RESULTS: For patients having undergone SOHND, the 5-year survival probabilities were 70.2% and 76.5% in N0 and N1 necks, respectively. The neck recurrence rate in SOHND was 2%. CONCLUSIONS: SOHND is an effective method of treatment for the clinically negative neck in patients with squamous cell carcinoma of the oral cavity. It also proves efficient, in conjunction with postoperative radiotherapy, for control of neck metastases in selected patients.

[Standards, options and recommendations (SOR) for clinical care of squamous cell carcinoma of the oropharynx. Groupe de travail SOR]. / Standards, Options et Recommandations pour la prise en charge des patients atteints de cancer épidermoïde de l'oropharynx.

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature systematic review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the management of squamous carcinoma of the oropharynx. METHODS: Data have been identified by literature search using Medline (1991-1998) and the expert groups personal reference lists. Once the guidelines were defined, the document was submitted for review to national and international independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for squamous cell carcinoma of the oropharynx management are that: 1) diagnosis and initial assessment should be based on appropriate clinical and radiological findings; 2) the therapeutic strategy is based on surgery, radiotherapy, bradytherapy and chemotherapy; 3) in limited tumours, the recommended strategy involved the use of one of these modality; 4) a multimodality approach is recommended for the treatment of extended resectable tumours. Following results of recent meta-analyses, use of neo-adjuvant chemotherapy is not recommended. The same studies have shown that association of chemotherapy and radiotherapy either in sequence or in combination significantly improve survival of extended curable tumours. These associations are recommended within the framework of clinical trials; 5) follow-up of squamous carcinoma of the oropharynx should involve physical examination of the upper aerodigestive tract and the lymph nodes areas every three months during the first year, every six months during the second year and then every year. An annual chest x-ray is recommended. Other investigations should be performed as indicated by symptoms and clinical manifestations.

[Prosthetic breast reconstruction and radiotherapy: analysis of 67 cases)]. / Reconstruction mammaire prothétique et radiothérapie: analyse de 67 cas.

Authors inquire into repercussions of radiotherapy (RT) on prosthetic mammary reconstruction (PMR) by using the retrospective analysis of 67 cases, 59 of which were performed in irradiated areas. The particular aspect of irradiated prosthesis is evoked regarding 8 cases, and with the support of a literature review. Surgical complications and late results are evaluated comparatively to 339 PMR among non irradiated patients. According to available data in our series, harmfulness of RT not appeared statistically demonstrated. From both their experience and the literature, authors clarify indications of PMR following RT. They conclude to the necessity of a high quality RT, and optimal adaptation of surgical technique to tissular conditions.

[Results of 10 years of a randomized trial of neoadjuvant chemotherapy in breast cancers larger than 3 cm]. / Résultats à 10 ans d'un essai randomisé de chimiothérapie néo-adjuvante dans les cancers du sein de plus de 3 cm.

AIM OF THE STUDY: The aim of this randomised trial was to determine advantages and drawbacks of neo-adjuvant chemotherapy in patients with operable breast cancers > 3 cm. MATERIAL AND METHODS: Two hundred and seventy-two women (age 70) with operable breast cancers larger than 3 cm (T2-3/N0-1/M0) were included in a randomised trial from January 1, 1985 to April 30, 1989. Patients in group A (n = 138) were treated by mastectomy and axillary node dissection. Adjuvant chemotherapy was indicated for 104 patients with axillary node involvement (n = 82) or negative oestrogen and progesterone receptors (EPR-) (n = 22). Patients in group B (n = 134) were treated by initial chemotherapy (identical as in group A) followed by locoregional treatment according to the response. Before treatment, the average of clinical tumoural diameter was 43 mm. RESULTS: The median follow-up was 124 months. In group B, 49 patients (36.5%) were resistant to chemotherapy; a conservative breast surgical treatment was performed in the other 84 patients sensitive to chemotherapy (62.6%). In this last subgroup, 19 (22.6%) needed a secondary mastectomy because of locoregional recurrence. Survival rates were not different in groups A and B, but loco-regional recurrences were frequent in group B. At 10 years, the overall survival rate was 60% and half of living patients in group B were free of cancer and with their breast. CONCLUSION: Neoadjuvant chemotherapy permitted in two-thirds of cases breast conservation treatment, initially considered to be impossible. Locoregional recurrences are more frequent than after mastectomy and adjuvant chemotherapy.

[Recurrence after treatment of breast intraductal carcinoma]. / Les récidives après traitement des carcinomes intracanalaires du sein.

OBJECTIVE: To assess the risk of local recurrence of intraductal carcinoma of the breast with a large series and a review of literature. METHODS: We present a retrospective study of 331 cases treated for intraductal carcinoma of the breast. Only patients with at least 5 years follow-up were selected. We were specially interested in recurrence risk factors. In these patients with a long follow-up; pathology was reevaluated with new investigation technique. RESULTS: After a median follow-up of 109 months, 40 local recurrences were observed; these lesions were invasive in 23 cases. Only one patient had recurrence after mastectomy. For the others, they had lumpectomy associated with radiotherapy in 12 cases. Histologic features, grade and therapeutic options were evaluated as risk factors of local recurrence. CONCLUSION: Follow-up after lumpectomy for intraductal carcinoma was studied. The status of tumor margins was important; irradiation appeared useful, specially in case of high grade carcinoma but further large prospective randomized studies are needed. The use of prognostic index is interesting, but there are still unanswered questions.

Accuracy of Goldmann tonometry after refractive surgery.

PURPOSE: To assess the accuracy of Goldmann tonometry after refractive surgery. SETTING: Refractive surgery center, Sherbrooke, Quebec, Canada. METHODS: The charts of 824 patients who had radial keratotomy (RK) and 415 who had photorefractive keratectomy (PRK) by the same surgeon were retrospectively reviewed. Of these, 306 RK and 168 PRK patients had discontinued steroid use for at least 4 weeks postoperatively and were thus eligible for evaluation of preoperative and postoperative intraocular pressure (IOP). Only one eye per patient was used for statistical analysis. RESULTS: Preoperative data showed that age, mean keratometry, and pachymetry were related to IOP measurement with the Goldmann tonometer. Pachymetry was related to age and mean keratometry. The mean decrease in measured IOP after RK was 1.0 mm Hg +/- 3.21 (SD) (P < .05). The only positive correlation was with the number of incisions. The mean decrease in measured PRK was 2.4 +/- 3.02 mm Hg (P < .05). Men and older patients had a larger drop in IOP measurements. There was no correlation with any corneal or operative parameter. CONCLUSION: Refractive surgery changed the accuracy of the Goldmann tonometer, causing it to underestimate IOP. The change was more marked in older men who had PRK.