[Information security in a radiotherapy centre: Controlling risks to better cope with them]. / Sécurité de l'information en centre de radiothérapie : contrôler ses risques pour mieux y faire face.

The dematerialization of data, the multiplication of sharing and exchanges between professionals, the increase of business software offer (patient files, human resources management, financial management, document management, etc.) question us about the security of information systems. This protection contributes to the quality of the care of patients in respect of their rights, to ensure the confidentiality, traceability and sustainability of digital personal health data and to strengthen the confidence of professionals in the system and its uses. But what security procedures are currently being undertaken in the radiotherapy centres?

[From quality management to dynamic management through quality: Deployment within a radiotherapy group]. / De la démarche qualité vers la gestion dynamique par la qualité : déploiement au sein d'un groupe de radiothérapie.

In 2015, the quality group of the radiotherapy clinic Groupement de Radiothérapie et d'Oncologie des Pyrénées (GROP, Pau, France) decided to review the deployment of its quality approach in order to optimize it continuously. For this, two improvements were proposed: an involvement of process drivers and a material and financial investment in document management software. The implementation of these organizational and managerial provisions enabled us to better cover the requirements of the ISO 9001 standard, the international reference in quality management.

Interest of video-assisted minimally invasive surgery in primary hyperparathyroidism.

INTRODUCTION: Surgery is the only radical and definitive treatment for primary hyperparathyroidism. Exploration of the four parathyroid sites is giving way to minimally invasive techniques. The present study sought to compare two minimally invasive parathyroidectomy techniques, by classical cervicotomy (MIP-C) and by video-assistance (MIP-VA), in terms of success rate, complications rate, operating time, and patient and community physician satisfaction. MATERIALS AND METHOD: A non-randomized retrospective comparative study included 112 patients presenting with primary hyperparathyroidism with identified parathyroid adenoma, operated on between January 2005 and October 2010. The two groups were constituted according to the surgeons' habitual practice: 54 cases of MIP-VA and 58 of MIP-C. RESULTS: Results for MIP-VA and MIP-C were respectively: success, 96.3% vs. 100% (P=0.09); mean scar size, 1.47 vs. 3.43cm (P<0.01); hypocalcemia, 2 vs. 3 cases (P=0.1); theater time, 94.25 vs. 76min (P=0.02); and postoperative stay, 1.08 vs. 1.37 days (P=0.07). Patient satisfaction was comparable between groups, while 93.3% of community physicians found MIP-VA preferable to MIP-C, although only 39.3% had known the MIP-VA technique. CONCLUSION: With efficacy, morbidity and patient satisfaction comparable to classical surgery, MIP-VA significantly reduced cervicotomy size and hospital stay. Community physicians considered it to be preferable to MIP-C.

Can hydrodynamic contact line paradox be solved by evaporation-condensation?

We investigate a possibility to regularize the hydrodynamic contact line singularity in the configuration of partial wetting (liquid wedge on a solid substrate) via evaporation-condensation, when an inert gas is present in the atmosphere above the liquid. The no-slip condition is imposed at the solid-liquid interface and the system is assumed to be isothermal. The mass exchange dynamics is controlled by vapor diffusion in the inert gas and interfacial kinetic resistance. The coupling between the liquid meniscus curvature and mass exchange is provided by the Kelvin effect. The atmosphere is saturated and the substrate moves at a steady velocity with respect to the liquid wedge. A multi-scale analysis is performed. The liquid dynamics description in the phase-change-controlled microregion and visco-capillary intermediate region is based on the lubrication equations. The vapor diffusion is considered in the gas phase. It is shown that from the mathematical point of view, the phase exchange relieves the contact line singularity. The liquid mass is conserved: evaporation existing on a part of the meniscus and condensation occurring over another part compensate exactly each other. However, numerical estimations carried out for three common fluids (ethanol, water and glycerol) at the ambient conditions show that the characteristic length scales are tiny.

Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents.

OBJECTIVES: Diagnostic and therapeutic processing of a thyroid nodule in children and adolescents may require lobectomy-isthmusectomy (LI) or nodule-resection (NR). Very few data in the literature report the long-term evolution of the remaining thyroid lobe in a defined pediatric population. In this study, we aimed to answer the following questions: Does a nodule recurrence occur in the remainder lobe? Is a post-operative thyroxine treatment necessary? MATERIAL AND METHODS: This retrospective study describes 28 patients under 18 who underwent LI (22 cases) or NR (6 cases) from January 2004 to March 2012. Ten of them were lost to follow up, 18 could be assessed (4 NR (22%) and 14 LI (78%) - mean follow-up 45±31 months). All patients benefited of post-operative thyroid ultrasonography, and regular endocrinologic follow-up. The following data were analysed: emergence of new thyroid nodules, evolution of pre-existing nodules, occurrence of post-operative hypothyroidism and requirement for completion thyroidectomy. RESULTS: The mean age at the time of surgery was 14.3±1.9 years. Two patients (11%) had pre-existing nodules in the remaining thyroid gland, none of which showed an increase in size after surgery. De novo nodules developed in five patients (27.8%). Three patients who underwent LI (21.4%) needed thyroxine treatment for post-operative hypothyroidism. One patient (5.5%) needed completion thyroidectomy. CONCLUSIONS: In this children and adolescents population, after performing LI or NR, remaining thyroid tissue stays free of nodules in 72.2% of the cases. A post-operative thyroxin treatment is necessary in 21.4% of cases after LI.

Thyroid surgery in children and adolescents: a series of 65 cases.

OBJECTIVES: To describe the specificities and complications of thyroid surgery in children and adolescents. MATERIAL AND METHODS: This retrospective study was based on 64 patients under the age of 18 who underwent thyroid surgery between January 2004 and March 2012, with two operations in one case. The following data were analysed: anatomical variants of the recurrent laryngeal nerve, postoperative recurrent laryngeal nerve paralysis rate, postoperative hypoparathyroidism rate, and histological results. RESULTS: Two cases of right non-recurrent inferior laryngeal nerve were observed (2.2% of the 93 recurrent laryngeal nerves dissected). One case of persistent left recurrent laryngeal nerve paralysis was observed (1.1%) despite intraoperative recurrent laryngeal nerve monitoring. Eight cases of immediate postoperative hypocalcaemia were observed (23.5% of the 34 total thyroidectomies) and permanent hypocalcaemia was observed in 5 cases (14.7%) with a significantly lower immediate postoperative serum calcium than in the case of transient hypocalcaemia (P=0.035). Among the 11 patients operated for familial medullary thyroid carcinoma (MTC), 36.3% presented one or more sites of C-cell carcinoma. Among the 32 patients operated for thyroid nodule, 6.3% presented papillary adenocarcinoma. Histological results were benign in all other cases. CONCLUSIONS: Thyroid surgery in children and adolescents is part of global multidisciplinary management of thyroid disorders in children. Recurrent laryngeal nerve paralysis is a rare complication, but may occur despite the use of intraoperative recurrent laryngeal nerve monitoring. Permanent hypoparathyroidism is the most common complication and is correlated with immediate postoperative serum calcium. Systematic prophylactic total thyroidectomy in patients with a RET proto-oncogene mutation allowed early diagnosis of MTC in one-third of cases. In view of the low rate of malignant nodules in our series, the malignant thyroid nodule rates reported in children in the literature may be overestimated.

Positron emission tomography-computed tomography evaluation for recurrent differentiated thyroid carcinoma.

OBJECTIVES: Recurrence is observed in 15-20% of patients under surveillance following treatment of differentiated thyroid cancer (DTC). However, due to cell dedifferentiation, the recurrence may be iodine-negative, thereby compromising detection. For this reason, new methods of exploration are indispensable to enable localization of such recurrences. The purpose of this work is to review the contribution of positron emission tomography-computed tomography (PET-CT) in the exploration of iodine-negative recurrent DTC. METHOD: A comprehensive review and discussion of the medical literature was carried out. RESULTS: Depending on the report, the sensitivity of PET-CT ranged from 70% to 85%, with up to 90% specificity. However, the large number of false negatives, which can reach 40%, is the disadvantage of this examination. PET-CT results lead to change in the therapeutic strategy in approximately 50% of patients with isolated raised serum thyroglobulin levels, and surgical exploration of a precise anatomical area in the neck. CONCLUSION: As post-treatment recurrence of a DTC can affect patient survival, a thorough diagnostic work-up is required in these cases. Where thyroglobulin levels are elevated with no uptake on 131-iodine scans, PET-CT can be a useful complementary exploration, especially for localizing the site of recurrence.

Cervical lymphadenopathies signaling thyroid microcarcinoma. Case study and review of the literature.

BACKGROUND: Some lateral cervical lymphadenopathies may lead to the discovery of papillary microcarcinomas (PMC) of the thyroid that are not radiologically apparent. This relatively rare clinical situation raises questions about the diagnostic approach to chronic cervical lymphadenopathy and the impact of lymph node metastasis on PMC prognosis. PURPOSE OF THE ARTICLE: To study the epidemiologic, clinical, and prognostic criteria of cases of lymphadenopathy that signaled PMC. PATIENTS AND METHODS: A retrospective study of 167 consecutive cases of PMC compared with 13 cases where a cervical mass signaled other forms of PMC. RESULTS: The mean age was 48.5 years, the ratio of men to women was 5:8, and the mean PMC size was 5.5mm. These data did not differently significantly from those of the other PMC cases. The preoperative imaging found fluid content in six cases, with microcalcifications in three cases. All cases were treated by modified radical neck dissection on the side with the lymphadenopathy and total thyroidectomy with central neck dissection. The lymphadenopathy included a ruptured capsule in five cases and was accompanied by central lymph node metastases in three cases. Thyroid capsule involvement was significantly more common in cases of PMC discovered due to lymphadenopathy than in other cases of PMC (69% versus 9.7%, respectively; p<0.001). The mean follow-up was 7.3 years. There were no deaths due to PMC signaled by lymphadenopathy. Two cases of lymph node recurrence after 8 and 10 years were controlled by another surgery and radioactive iodine treatment. CONCLUSION: Any chronic cervical mass should suggest the possibility of thyroid origin, especially in cases with cystic content or microcalcifications in subjects with no particular risk factors. An ultrasound of the thyroid should be done, as well as a fine needle aspiration biopsy of the lymphadenopathy with a thyroglobulin assay. Treatment is the same as for any thyroid carcinoma, and results in a good oncological outcome, despite the possibility of lymph node recurrences.

Writing an article for the European Annals of Otorhinolaryngology, Head and Neck Surgery: rights and responsibilities.

Based on a review of the literature published on medical writing, the authors discuss the rules to respect in terms of both structure and substance to facilitate publication of studies in the European Annals of Otorhinolaryngology, Head and Neck Surgery. The main errors leading to an article's being rejected are detailed and analyzed.

Drying of a solution in a meniscus: a model coupling the liquid and the gas phases.

A model simulating the drying of a solution in a meniscus in contact with a moving substrate is developed. It takes into account the hydrodynamics in the solution in the framework of the lubrication approximation, the vapor diffusion in the gas phase, and the variation of physical properties during drying. The free surface profile and spatial evaporation flux are not imposed a priori but result from the simulation of the mass transfer in the liquid/gas system (1.5-sided model). Several regimes are observed depending on the substrate velocity. For a large substrate velocity, the classical Landau-Levich regime is obtained. For smaller velocities, a drying front appears that is characterized by a strong concentration gradient and a peak in the evaporation flux. The coupling between the evaporation flux and the meniscus shape in this regime is analyzed. Another regime appears at a very low substrate velocity and seems to be driven by a competition between advection and diffusion. This macroscopic model simulates recent experimental results, namely, the dependence of the deposit thickness on the substrate velocity, which scales as 1/V in the regime dominated by evaporation.

Drying of colloidal suspensions and polymer solutions near the contact line: deposit thickness at low capillary number.

Drying experiments with a receding contact line have been performed with silica colloidal suspensions and polyacrylamide (PAAm) polymer solutions. The experimental setup allows to control the receding movement of the contact line and the evaporation flux separately. Deposit thickness as a function of these two control parameters has been investigated. The different systems exhibit a similar behavior: in the regime of very low capillary numbers the deposit thickness scaled by the solute volume concentration and the evaporation rate is proportional to the inverse of the contact line velocity. Both the scaling exponent and the constant (which has the dimension of a length) do not depend on the system under study. The observation of this evaporative regime confirms some recent results obtained by Le Berre et al. on a very different system (phospholipidic molecules) and fully supports their interpretation. Following their approach, a simple model based on mass balance accounts for these results. This implies that this regime is dominated by the evaporation and that the deformation of the meniscus induced by viscous forces does not play any significant role. When increasing the velocity, another regime is observed where the thickness does not depend significantly on the velocity.

Pemphigus vulgaris antigen mRNA quantification for the staging of sentinel lymph nodes in head and neck cancer.

BACKGROUND: Molecular diagnosis has been proposed to enhance the intra-operative diagnosis of sentinel lymph node (SLN) invasion in head and neck squamous cell carcinoma (HNSCC). Although cytokeratin (CK) mRNA quantification with real-time reverse transcriptase-PCR (QRT-PCR) has produced encouraging results, the more discriminating markers remain to be identified. METHODS: Pemphigus vulgaris antigen (PVA), squamous cell carcinoma antigen (SCCA), and CK17 mRNA were quantified using QRT-PCR, and the results were compared with an extensive histopathological examination of the entire SLNs on 78 SLNs harvested from 22 patients with HNSCC. RESULTS: SCCA and CK17 quantification showed significantly higher mRNA values for macrometastases (MAs) than for either negative or isolated tumour cell (ITC) SLNs (P<0.01). Pemphigus vulgaris antigen allowed the discrimination of all MAs and micrometastases from both negative and ITC SLNs (P<0.001). For the neck staging of patients, considering metastatic vs non-metastatic status, receiver-operating characteristic curve analysis found areas under the curve of 93.8, 97.9, and 100% for CK17, SCCA, and PVA, respectively. With PVA, a cutoff value of 562 copies per 100 ng of cDNA permitted the correct distinction between patients with positive as opposed to negative neck nodes in all cases. CONCLUSION: PVA seems to be a highly promising marker for accurate intra-operative SLN staging in HNSCC by QRT-PCR.

[Sinonasal adenocarcinomas reviewed. Prognostic value of WHO 2005 histological classification]. / Les adénocarcinomes nasosinusiens revisités. Intérêt pronostique de la classification histologique OMS 2005.

OBJECTIVES: The WHO 2005 histological classification separates sinonasal adenocarcinoma (ADC) into three classes: intestinal-type adenocarcinoma (ITAC), low-grade sinonasal ADC and high-grade sinonasal ADC. The goal of this study was to check the relevance of this classification on the prognosis of patients treated for ADC. PATIENTS AND METHODS: All the files of patients treated consecutively in the ENT department of the Montpellier University Hospital for ADC between 1980 and 2003 were retrospectively re-examined. Each case was reviewed for anatomical and pathological data based on the immunohistochemistry results according to the WHO 2005 classification, with a study of a panel of markers: cytokeratin 7 (CK7), cytokeratin 20 (CK20), Villin, CDX2 and EGFR. The epidemiologic data, the methods of treatment and the follow-up were studied. The survival probabilities were calculated using the Kaplan-Meier method and the survival graphs were compared using a log-rank test. RESULTS: Sixty-two files were reviewed. Twelve patients were reclassified into the adenoid cystic carcinoma category and excluded from the study. In the 50 remaining cases, there were 36 ITAC cases, four low-grade ADC cases and 10 high-grade dedifferentiated carcinomas. For all of the ADC cases, the total survival at 5 years and without recurrence was 64 and 52%, respectively. The analysis of the three subgroups showed a total survival of 72.2% for ITAC, 100% for low-grade and 20% for high-grade ADC with a significant difference (p=0.044). This immunohistochemical distinction was mainly based on the expression of CK20 found in 98% of the ITAC cases and absent in low- and high-grade ADC patients. CONCLUSION: The WHO 2005 classification for sinonasal ADC provides a valuable prognosis by showing a difference in the progression profile between ITAC, low-grade ADC and high-grade ADC. Moreover, broader studies should be conducted to investigate the different subtypes of ITAC.

Voice handicap evaluation after supracricoid partial laryngectomy.

OBJECTIVES: To gather information on the vocal and professional impact of supracricoid partial laryngectomy (SCPL). STUDY DESIGN: Collection of quality of life data more than 12 months postsurgery, including expert-rated patient voice assessment (GRBAS [grade, roughness, breathiness, asthenia, strain] scale), self voice assessment, Voice Handicap Index (VHI), and socioprofessional data. PATIENTS: Sixty-four patients were evaluated after SCPL. The surgical procedure had been conducted for initial stage T1b or T2 glottic carcinoma. All patients had no recurrence, were decanulated, and did not have any swallowing impairment. Thirty-three patients were less than 60 years old and were professionally active at the time of surgery. The mean age was 48.5 years old (42-59 years old). Fifteen patients were working in the communications sector, so use of their voice was obligatory. Professional impact and VHI measurements were evaluated. RESULTS: For patients with professional activities before surgery, 15/33 (45%) continued their activities, whereas 55% had to withdraw from or modify these activities. For patients with communications activities, 6/15 (40%) continued their activities, 4 (26.6%) adapted, and 5 (33.3%) withdrew from their professional activities. The mean VHI value was 51.2. The mean VHI values according to the dysphonic grade (1, 2, and 3) were 36.3, 50.7, and 52.9, respectively. The mean VHI values were 45.6, 58.6, and 53.2, respectively, for patients who pursued their professional activities, withdrew from or adapted their activities, and had no professional activities. Correlations were obtained between VHI and the dysphonic grade (P = .043), cessation of professional activities (P = .034), and the time elapsed since surgery (P = .046). VHI emotional and physical subscale scores were significantly higher for patients who had withdrawn from their professional activities or adapted them. CONCLUSIONS: Supracricoid partial laryngectomy can have a marked social and professional impact. Many patients have to withdraw from professional activities in which vocal involvement is essential. The potential postsurgical social voice impact should be taken into consideration before proposing this surgery, and it is essential to estimate the possible impacts of the vocal handicap according to the patient's professional or other activities.

An unusual succinate dehydrogenase gene mutation C in a case of laryngeal paraganglioma.

OBJECTIVE: To report a rare case of a laryngeal paraganglioma related to succinate dehydrogenase gene mutation C. METHOD: A case report and a review of the world literature concerning succinate dehydrogenase mutations and laryngeal paraganglioma are presented. RESULTS: We identified a laryngeal paraganglioma in a 38-year-old woman, related to a very rare, deleterious in exon 4 of the succinate dehydrogenase mutation C. This mutation was a non-sense mutation: c.183G >A leading to p.Trp61X. No other neuroendocrine tumour was identified in this case, but a thyroid papillary carcinoma was concomitantly discovered and cured. CONCLUSION: To our knowledge, this is the first report in the world literature of laryngeal paraganglioma related to a succinate dehydrogenase mutation C. The case presented underlines the fact that every patient with paraganglioma should be tested for succinate dehydrogenase genetic mutations, even if a family history of paraganglioma is absent, in order to enable appropriate clinical management and to improve our knowledge of familial paraganglioma.

[Study of the platysma coli muscle vascularisation by the facial artery. Implication during the elevation of the musculo-cutaneous platysma coli muscle flap]. / Etude de la vascularisation du muscle platysma coli par les branches de l'artère faciale. Implications lors du prélèvement du lambeau musculo-cutané de platysma coli.

AIM OF THE STUDY: The purpose of this study was to assess the vascularity of the platysma muscle by the branches of the facial artery, in order to determine the best means of harvesting a musculo-cutaneous flap while ensuring maximum vascular security. PATIENTS AND METHODS: Ten platysma muscles were dissected on 4 fresh specimens and one formaldehyde-preserved specimen. The dissection was performed after injection of the facial artery in 6 cases, while 4 muscles were dissected without any previous injection. RESULTS: The vascular supply of the platysma muscle comes essentially from the branches of the submental artery and from branches descending straight from the facial artery. Other collateral branches contribute to this vascularization, but their importance is minor. All these arteries reach the muscle, entering its visceral aspect, then proceed to the sternal notch in a radial axis. CONCLUSION: The size of the flap has to be defined within a quadrilateral figure with its base formed by the mandibular edge and its apex by the inferior limit of the flap. It is essential to preserve the maximum possible muscular thickness, especially on the medial side of the flap. If the facial artery needs to be ligated, this has to be done as it enters the submandibular space in order to protect most of the collateral branches destined to the muscle. The vascularization is then taken back by the homo- and contro-lateral facial vascularisation in an inverted flow in the remaining segment of the facial artery.