[Microscopic peritoneal metastases of epithelial ovarian cancers. Clinical relevance, diagnostic and therapeutic tools]. / Métastases péritonéales microscopiques des cancers épithéliaux de l'ovaire. Pertinence clinique, outils diagnostiques et thérapeutiques.

Understanding the biology and progression mechanisms of peritoneal metastases in ovarian epithelial cancers (EOC) is important because peritoneal carcinomatosis is present or will occur during surveillance of a majority of patients. Despite the clinical remission achieved after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, 60% of patients will develop peritoneal recurrence. This suggests that microscopic lesions, which are not eradicated by surgery may be present and may participate in the mechanisms leading to peritoneal recurrence. This paper discusses current available data on microscopic peritoneal metastases, their diagnosis and their treatment. We reviewed all publications dealing with microscopic peritoneal metastases of EOC between 1980 and 2017. The most recent and most relevant publications dealing with the treatment modalities of these metastases were selected. Peritoneal and epiploic microscopic localizations would occur in 1.2 to 15.1% of cases at early-stage and are not treated during conventional surgery. They could represent a potential therapeutic target. Local treatments (intraperitoneal chemotherapy, photodynamic therapy, fluorescence-guided surgery) seem to be necessary in addition to surgery and chemotherapy and may help reduce the risk of peritoneal recurrence. The place of these treatments in the management of EOC remains to be defined by subsequent researches.

[Current controversies regarding power morcellation and future directions]. / Morcellement utérin : controverses actuelles et futurs développements.

Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.

Impact of axillary dissection in women with invasive breast cancer who do not fit the Z0011 ACOSOG trial because of three or more metastatic sentinel lymph nodes.

AIM: The objective of this study was to determine the effects of axillary lymph node dissection (ALND) versus sentinel lymph node biopsy alone (SLNB) on the survival of patients with 3 or more metastatic lymph nodes (MLN) in invasive breast cancer. METHODS: Data of 9521 patients with invasive T1-2M0 breast carcinoma and initial treatment with SLNB completed or not by ALND and 3 or more MLN were extracted from the SEER database. Univariate and multivariate analyses were performed. RESULTS: Overall, 9521 patients were included in the study. SLNB-alone compared with ALND did not result in different overall survival (OS) or specific survival (SS) for patients with 3 or more MLN (p = 0.46 and 0.58, respectively). In subgroup analyses, OS was comparable between SLNB-alone and ALND when patients had only 3 or more than 3 MLN. When patients had 3 MLN, the 5-year SS was significantly better for patients with ALND compared with SLNB-alone: 91.5% and 85.1%, respectively (p = 0.02). The Hazard Ratio (HR) for OS comparing SLNB-alone with ALND adjusting for age, adjuvant radiotherapy, tumor size, estrogen receptor status, grade and tumor type resulted in an HR of 1.05 (95% CI, 0.72-1.54, p = 0.77). CONCLUSION: In conclusion, patients with a T1-T2 invasive breast cancer and at least 3 MLN do not benefit from ALND after SLNB for specific and overall survival, thus limiting ALND to a staging procedure. A subgroup of patients with 3 MLN had a better SS with ALND, possibly due to an under-staging of the SLNB-alone group.

Papiledema secundario a meningitis tuberculosa en paciente con diabetes mellitus tipo 1 / Papilledema secondary to tuberculous meningitis in a patient with type 1 diabetes mellitus

Caso clínico: Mujer de 29 años de edad, que refería cefalea de varios días de evolución, con posterior pérdida de visión y dolor en su ojo izquierdo. Como antecedentes: diabetes mellitus tipo 1, de 3 años de evolución y ser inmigrante de Ecuador. El examen fundoscópico reveló un papiledema. La reacción en cadena de la polimerasa (PCR) en líquido cefalorraquídeo fue positiva para Mycobacterium tuberculosis (MTB). Posteriormente al tratamiento con tuberculostáticos presentó una mejoría marcada. Discusión: La tercera parte de la población mundial presenta una infección latente por MTB; existe una comorbilidad entre diabetes mellitus y tuberculosis, principalmente en los países en vías de desarrollo (AU)

Case report: The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs. Discussion: About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries (AU)

[Papilledema secondary to tuberculous meningitis in a patient with type 1 diabetes mellitus]. / Papiledema secundario a meningitis tuberculosa en paciente con diabetes mellitus tipo 1.

CASE REPORT: The case is presented of a 29-year-old woman who complained of headache over a period of several days, with loss of visual acuity and pain in her left eye. She had a 3-year history of type 1 diabetes mellitus, and was an immigrant from Ecuador. The funduscopic examination revealed a papilledema. The polymerase chain reaction (PCR) study of the cerebrospinal fluid was positive for Mycobacterium tuberculosis (MTB). She showed a marked improvement after treatment with anti-TB drugs. DISCUSSION: About a third of the world's population has a latent infection of MTB, comorbidity between diabetes mellitus and tuberculosis has been reported, particularly in undeveloped countries.

[Photodynamic therapy and prostate cancer]. / Thérapie photodynamique et cancer de la prostate.

PURPOSE: Photodynamic therapy (PDT) is an innovative therapeutic modality in urologic oncology. MATERIAL AND METHODS: We reviewed the current literature on principles and modalities of PDT in prostatic oncology. RESULTS: Focal therapy of prostate cancer is an application field of PDT. Clinical phase II studies are ongoing to determine PDT efficacy and safety in this indication. PDT as salvage treatment after prostatic radiotherapy has been tested. Carcinologic results were promising but important side effects were reported. Individual dosimetric planification is necessary to avoid this toxicity. CONCLUSION: PDT first clinical experience for prostate cancer has showed its technical feasibility. Several research ways are currently in study to improve carcinologic efficacy and to limit potential side effects.

[Urethrovaginal fistulae resulting from sub-urethral slings for stress urinary incontinence treatment. A report of two cases and review of the literature]. / Fistules urétrovaginales après cure d'incontinence urinaire d'effort par bandelettes sous-urétrales. A propos de deux cas et revue de la littérature.

Urethrovaginal fistula is an extremely rare condition after surgical treatment of stress urinary incontinence using a suburethral sling. We report two cases of urethrovaginal fistulae after surgical treatment of stress urinary incontinence using polypropylene monofilament material, that have been managed with clinical evaluation, removal of the sling and treatment of the fistula. It is a rare but severe and invalidating complication of "mini-invasive" techniques, not just for the functional results but also for the patient's social condition. The aim of this article is to describe clinical presentation and treatment of this complication that every surgeon practicing vaginal surgery should know and keep in mind when recurrent SUI.

[Diagnosis of cervical squamous intraepithelial lesions by fluorescence imaging: clinical feasibility study]. / Diagnostic des lésions malpighiennes intraépithéliales par colposcopie en fluorescence: étude de faisabilité clinique.

OBJECTIVE: Fluorescence diagnosis is still undeveloped in gynaecology. In order to diagnose and localize squamous intraepithelial lesion (SIL) of the cervix, a new method improving the low specificity of colposcopy would be useful. The goal of this study was to assess the feasibility and safety of colposcopic fluorescence diagnosis of SIL after topically application of methyl aminolevulinate (MAL). PATIENTS AND METHODS: Patients with histologic proved cervical intraepithelial neoplasia (CIN) and planned for loop electrosurgical excision procedure (LEEP) under general anesthesia were included in a prospective study. Before general anesthesia, a thick layer of MAL (Metvix-160 mg/mL cream) was applied on the cervix for 35-150 min. Fluorescent colposcopic inspection of the cervix was performed using a rigid 10-mm laparoscope inserted in the vaginal cavity and connected to D-light AF system (Karl Storz Endoskope, Tuttlingen Germany). In order to confirm neoplasic status, fluorescent foci underwent directed punch biopsy(ies). RESULTS: Fourteen patients were included in the study. Colposcopic fluorescence imaging revealed red fluorescent foci in 71.4% of cases (10/14) (neoplasic status of fluorescent foci was confirmed in 80%). Concerning MAL, the mean of application time was 73 min (35-150). Two cases presented a false-positive fluorescence and four cases of false-negative fluorescence. For all cases of false-negative fluorescence, application time of MAL was less than 60 min. We observed no systemic or local toxicity of MAL application in any group. DISCUSSION AND CONCLUSION: Using topical application of MAL to the cervix, we demonstrated that fluorescence diagnosis of SIL is feasible. This study justifies the further development of fluorescence imaging that combines classical white light colposcopy with the use of a photosensitizer.

[Left-handedness and diabetes mellitus of autoimmune origin]. / Zurdería y diabetes mellitus de origen autoinmune.

A controversial theory postulates that there is an association between left handedness and immune and speech disorders. There are reports of increased frequency of left handedness in type I diabetic patients. The aim of this study was to compare 65 type I diabetics, 65 type II diabetics and 130 normal controls using a 7 item questionnaire for handedness. No differences were found for strong left handedness. However the frequency of strong right handedness decreased significantly from controls to type II diabetics and type I diabetics. Since less intense right handedness is not the same as left handedness, it is concluded that the theory is not supported by the present findings.