[Should chest wall irradiation be included after mastectomy and negative node breast cancer?]. / L'irradiation pariétale est-elle justifiée après mastectomie et curage négatif ?

PURPOSE: This study aims to evaluate local failure patterns in node negative breast cancer patients treated with post-mastectomy radiotherapy including internal mammary chain only. PATIENTS AND METHODS: Retrospective analysis of 92 internal or central-breast node-negative tumours with mastectomy and external irradiation of the internal mammary chain at the dose of 50 Gy, from 1994 to 1998. RESULTS: Local recurrence rate was 5 % (five cases). Recurrence sites were the operative scare and chest wall. Factors associated with increased risk of local failure were age < or = 40 years and tumour size greater than 20mm, without statistical significance. CONCLUSION: Post-mastectomy radiotherapy should be discussed for a sub-group of node-negative patients with predictors factors of local failure such as age < or = 40 years and larger tumour size.

The effects of endocrine and mechanical stimulation on stage I lactogenesis in bovine mammary epithelial cells.

The study objective was to evaluate the effect of endocrine and mechanical (gel release) signaling on bovine mammary epithelial cell ultrastructure and gene expression. Cultures receiving only one stimulus demonstrated partially differentiated ultrastructure, which included abundant polysomes, limited rough endoplasmic reticulum, and absence of secretory products, whereas the 2 stimuli together induced a more complete lactogenic phenotype that included increased rough endoplasmic reticulum, abundant lipid droplets, and secretory vesicles containing casein micelles. The structural data indicated that although synthesis of milk components was initiated, the copious synthesis and secretion associated with stage II lactogenesis was not evident. Microarray analysis revealed that both prolactin and gel release independently regulated several genes linked to a wide array of cellular activities. In combination, they regulated fewer genes targeted to lactogenesis. Genes regulated by the combination treatment included claudin 7, multiple caseins, xanthine oxidoreductase, and several protein synthesis, packaging, and transport genes. Genes related to structural activity including keratin 15 (morphogenesis), alpha-spectrin (cell shape via actin cytoskeleton), and chitinase-like protein 1 (tissue remodeling) were up-regulated by the combination treatment as was the transcription factor Kruppel-like factor 2 (KLF-2). However, Snail 2, which down-regulates and inhibits tight junction components, was repressed in response to the combination treatment. These results suggest coordination between endocrine and physical signals at the genomic level that produces a more specific and targeted transcriptional response associated with stage I lactogenesis. A molecular pathway analysis of the differentially expressed genes revealed that genes regulating cell signaling were linked to those regulating cell structure and adhesion.

[Autologous versus homologous transfusion in cervico-fascial oncologic and ENT surgery]. / Transfusion autologue versus. Transfusion homologue en chirurgie oncologique cervico-faciale et ORL.

The objective was to evaluate the interest of the normovolemic hemodilution (NVH) in cervico-facial oncologic and ENT surgery. It was a prospective, randomised and simple blind study having included A(n = 17) having benefitted before induction of a blood withdrawal of 6-8 ml.kg-1, substituted by an intravenous drip of colloid. B group (n = 21). The transfusional objective having been to assure for the two groups, during operative and in postoperative periods, a rate of Hb > or = 10 g.dl-1 and a rate of Ht > or = 30%. The two groups were comparable for the demographic and anesthetic characteristics, and the blood losses during operative period. A variation significantly more important between before and postoperative hemoglobin has been objectified in the group A. The infectious morbidity was significantly more elevated in the group A (23.5% versus 4%). The cost was distinctly more elevated in the hemodiluted group. The NVH doesn't seem to be an indication of choice in the cervico-facial and ENT oncologic surgery.