Modulation of ER phosphorylation on serine 118 by endocrine therapy: a new surrogate marker for efficacy.

BACKGROUND: Phosphorylation of serine 118 (ser118) has been reported to be involved in the activation of estrogen receptor (ER). In the present study, we evaluated whether endocrine therapy modulated ER phosphorylation on ser118. PATIENTS AND METHODS: We carried out a tissue microarray that included 80 primary breast tumors obtained before the administration of endocrine therapy. A second tissue microarray included 52 tumors obtained after endocrine therapy from the same patients. Immunostainings were carried out for ER, Pser118ER, Her2, insulin growth factor receptor (IGFR), p21-activated kinase 1 (PAK1), pMAPK, bcl2 and progesterone receptor. RESULTS: Pser118ER staining was higher in Her2- (P = 0.06), IGFR- (P = 0.0002) and pMAPK-expressing tumors (P = 0.001). The level of ER phosphorylation was not different according to the occurrence of clinical tumor response (P = 0.16). Pser118ER expression was significantly reduced by endocrine therapy. The mean Pser118ER score was 163 [standard deviation (SD) 81] before endocrine therapy and 80 (SD 90) after endocrine therapy (P = 0.0001, paired t-test). The magnitude of Pser118ER decrease was higher in tumors that responded to endocrine therapy (mean decrease 128, SD 86) as compared with refractory tumors (mean decrease 38, SD 130) (P = 0.017, t-test). CONCLUSION: These findings suggest that endocrine therapy modulates ER on ser118. Pser118ER immunostaining could be used as surrogate marker to monitor treatment efficacy.

The antivenom efficacy against a viper bite without medical treatment for 3 days: a case report.

Snakebites can be deadly, depending on the course of extremely serious hemorrhagic complications in the absence of antivenom, which remains the only specific and effective treatment, if it is introduced in time. We report the case of a young patient of 18 years, bitten by a snake and receiving only tradition care until admission to intensive care 3 days later, with advanced bleeding and inflammation; four vials of FAV-Africa antivenom were administered and resulted in dramatic improvement in his condition. This result confirms the empirical concept that delay in management should under no circumstances exclude the administration of antivenom.

[Moroccan experience in the surgical treatment of multiple hydatid cysts in the liver]. / L'expérience marocaine dans le traitement chirurgical des kystes hydatiques multiple du foie: à propos de 94 cas.

We studied 94 cases of multiple hydatid cysts in the liver, over a period of ten years. These cases accounted for 31.3% of all cases of hydatid cysts treated surgically in the Visceral Surgery Department of Avicenne Military Hospital in Marrakech. In these patients, who were often young and male, the principal symptoms were pain in the right hypochondrium (71.3%) and hepatomegaly (24.5%). In about 10% of cases, the cysts were discovered by chance. Ultrasound and CT scans facilitated diagnosis and determination of the position of the cysts, with reliability reaching 100% for CT scans. The cysts had burst in the bile ducts in 26.6% of cases and were infected in 8 cases. They were multivesicular in 77.5% of cases. Association with hydatidosis at another site was observed in 28 cases: in the peritoneum in 15, the thorax in 7, the diaphragm in 4, the spleen in 2 and the kidney in 1 case. Surgically, the route most frequently used was double incision below the rib cage (49.5%). It is not possible to recommend one particular way to treat cysts and the most appropriate approach to treatment depends on the site, type and number of cysts. Resection of the prominent dome is the technique most frequently used (57.25%). However, in recent years, the use of cystectomy has been increasing (20.2%) due to the considerable decreases in post-operative morbidity and duration of hospital stay that it affords. The principal post-operative complications observed were abscesses under the diaphragm (6 cases), biliary leakage (5 cases), pleurisy (6 cases) and the formation of abscesses in the vestigial cavity (4 cases). The rate of morbidity in the RDS appeared high, accounting for 75% of total morbidity. Only one patient died. This patient died from severe hepatic insufficiency due to the near destruction of the liver by the hydatosis. We observed two recurrences during follow up. Both underwent further surgery and neither suffered complications.

[Peritoneal hydatidosis: a study of 25 cases in Morocco]. / Hydatidose péritonéale. A propos de 25 cas marocains.

We carried out a retrospective study of 25 cases of peritoneal hydatidosis. The incidence of this disease was 6.9%, the sex ratio of the patients was about 2/1 and the mean age of the patients was 31.8 years. Peritoneal echinococcal disease was most frequently secondary to the rupture or splitting of hydatid cysts in the liver (84% of cases) or, more rarely, in the spleen (4% of cases). The principal symptoms were unusual abdominal pain and abdominal masses. Ultrasound scan is the radiological method of choice for investigation and for assessing the number of hydatid cysts in the abdomen. It was used in 20 cases in this series and led to diagnosis of the disease in 95% of these cases. The sensitivity of CT scan for topographical diagnosis was about 90%. Serological tests were negative for the five remaining patients. Surgical management depends on the location and number of hydatid cysts and on the general state of the patient. Total cyst removal was performed in ten patients, pericystectomy in nine cases and marsupialization in six cases in which the cysts were located in the Douglas cul-de-sac. None of the patients was treated with albendazole. None of the patients died and the morbidity rate was 20%, due mainly to the hepatic location of the cysts. We observed one case of small bowel occlusion due to a missed daughter vesicle, two abscesses of the residual cavity, one case of pleurisy and one case of unexplained febrile syndrome. No recurrence was observed over a follow-up period of five years.

[Chickenpox: a cause of acute respiratory distress syndrome to bear in mind]. / La varicelle: une étiologie de syndrome de détresse respiratoire aiguë à ne pas méconnaître.

The authors report a case of chickenpox (varicella) in an adult, complicated by acute respiratory distress syndrome and resulting in death.

Male breast cancer. Evolution of treatment and prognostic factors. Analysis of 489 cases.

BACKGROUND: Infiltrating MBC represents less than 1% of all male cancers. Our study details clinico-pathological features, treatments and prognostic factors in a large French cohort. MATERIAL AND METHODS: Four hundred and eighty-nine patients were collected from 1990 to 2005. Median age was 66 years (34% over 70 years) and median follow-up 58 months. RESULTS: According to TN classification, we found T(1): 39%, T(2): 41%, T(3)T(4): 9%, T(x): 11% and N(1)N(2): 27%. Lumpectomy (L) and mastectomy (M) were performed in 8.6% and 91.4% of the cases. Axillary dissection (AD), sentinel node biopsy or both were performed in 90%, 2% and 5% of the cases, respectively. Ninety-five percent of tumours were ductal carcinomas; 47% were pT(1), 20% pT(2) and 33% pT(3)-T(4). Axillary nodal involvement was present in 52.8% cases. ER and PgR were positive in 92% and 89% cases. Radiotherapy (RT) was performed in 85% of the patients. Hormonal treatment (HT) was delivered in 72% of the cases. Tamoxifen and aromatase inhibitors were used in 85% and 12% of the cases; 34% of the patients received chemotherapy (CT). Local recurrence (LR), nodal recurrences (NR) and metastases occurred in 2%, 5% and 22% of the cases; 2% and 10% developed contralateral BC and second cancer. The 5- and 10-year overall survival (OS) rates were 81% and 59%; disease-specific survivals (DSS) were 89% and 72%. Death causes were BC 56%, second cancer 8%, complications 3%, intercurrent disease 15% and unknown 18%. In a univariate analysis, metastatic risk factors were T stage (T1: 19%, T(2): 26%, T(3)T(4): 40%; p=0.013), pN status (pN(0): 12% pN(1-3): 26% pN(>3): 44%; p<0.0001) and presence of locoregional recurrence (62% versus 18% p<0.0001). In a multivariate analysis, axillary nodal involvement and high SBR remain prognostic factors. CONCLUSION: Earlier diagnosis and wide use of adjuvant treatments (RT/HT/CT) widely decreased LR and increased survival rates in MBC, reaching female ones. Prognostic factors were also very similar to female ones.