Lessons learned about appendiceal neuroendocrine neoplasms from data analysis of the Belgian Cancer Registry 2010-2015.

BACKGROUND AND STUDY AIMS: Appendiceal neuroendocrine neo-plasms (aNENs) are a diverse group of malignant neoplasms of varying biological behavior for which information about manage-ment and outcome is sparse, with the majority of available studies being retrospective, including only a limited number of patients, and therefore not necessarily reflecting the reality in the community. In the present study clinical, epidemiological and pathological data of appendiceal neuroendocrine neoplasms in Belgium is provided and compared with current literature. METHODS: A population-based study was conducted by linking data of the Belgian Cancer Registry with medical procedures in the Belgian Health Insurance database for patients diagnosed with aNEN between 2010 and 2015. RESULTS: We found an aNEN incidence of 0.97/100.000 person years in Belgium. Neuroendocrine carcinoma of the appendix are rare. Most appendiceal neuroendocrine tumors (aNETs) are small G1 tumors. Positive lymph nodes are often found in tumors larger than 2cm, especially aNET G2. CONCLUSION: A rapid uptake of changing classifications was seen in the community. However, systematic reporting of risk factors for small aNEN can still be improved and should be stimulated. In 9% of cases, reclassifications had to be made, pointing out that in a retrospective analysis, original pathological reports should be checked for specific parameters, before reliable conclusions can be drawn.

[Custom made chest-wall implant and Poland's syndrome: Between art and science]. / Prothèse sur mesure et syndrome de Poland : entre art et science.

Poland's syndrome is a well-described congenital thoracic deformity with mostly only an aesthetic damage. We report the case of a chest-wall correction of a young male patient by a custom made silicone implant, detailing the original process of manufacturing, and justifying the choice not to use a conventional technique of reconstruction. This alternative enhances the surgeon's therapeutic arsenal, so that he can provide a customized answer, adapted to the requirements and the morphological characteristics of each patient.

Current practice in approaching controversial diagnostic and therapeutic topics in gastroenteropancreatic neuroendocrine neoplasm management. Belgian multidisciplinary expert discussion based on a modified Delphi method.

BACKGROUND AND STUDY AIMS: Neuroendocrine neoplasms (NENs) are relatively rare, with marked clinical and biological heterogeneity. Consequently, many controversial areas remain in diagnosis and optimal treatment stratification for NEN patients. We wanted to describe current clinical practice regarding controversial NEN topics and stimulate critical thinking and mutual learning among a Belgian multidisciplinary expert panel. PATIENTS AND METHODS: A 3-round, Delphi method based project, coordinated by a steering committee (SC), was applied to a predefined multidisciplinary NEN expert panel studying the following controversial topics : factors guiding therapeutic decision making, the use of somatostatin analogues (SSA) in adjuvant setting, the interference between non-radioactive and radioactive SSAs, challenging small intestine neuroendocrine tumor (NET) cases, the approach of the carcinoid syndrome, the role of chemotherapy in well differentiated NET, the relevance of NET G3 and neuroendocrine carcinoma subclassification and the role of imaging techniques in NEN management. RESULTS: A high level of consensus exists regarding the necessary diagnostic work-up, use of imaging techniques and interference between non-radioactive and radioactive SSAs. However, the prognostic impact of tumor functionality might be overrated and adequate diarrhea differential diagnostic work-up in these patients is underused. Significant differences are seen between individual experts and centers regarding treatment preferences both on the treatment modality level, as well as the choice of specific drugs (e.g. chemotherapy regimen). CONCLUSIONS: A Delphi-like multi-round expert discussion proves useful to boost critical thinking and discussion among experts of different background, as well as to describe current clinical practice and stimulate mutual learning in the absence of high-level scientific guidance.

[French plastic surgeons: update in 2007]. / Chirurgiens plasticiens français: état des lieux en 2007.

French medical demography is a true public health issue. The medicine doctor's scarcity announced by many will not appear for the plastic surgeons. In this speciality, problems are an excess staff and irregular sharing out. The aim of the study was to make a very sharp update of the speciality thanks to an actual demographic descriptive and analytic study compared with the one realised in 1998 including a French plastic surgeon's activity study. In 2007, there were 889 plastic surgeons in France, so 235 surgeons more than in 1998 and an average of 26 new plastic surgeons a year. The plastic surgeon's density was 1 for 71,174 people, much more important than the recommended value. The distribution of these surgeons is still unequal and the excess staff is getting worse. The plastic surgeon's activity study based on the Information System Medicalisation Program (ISMP) between 2004 and 2006, including 13 classic plastic surgery's procedures, showed an important decrease of the activity especially for the private sector. The analytic study put together the data concerning the demography and the activity considering the economic side of esthetic surgery. Thanks to these data, plastic surgeons will now be able to choose their working area not only based on geographic reasons but also depending on the activity they want and on the importance of the competition. This work stands for a help for plastic surgeons, in the hope of a fair sharing out of these practioners.

[Role of the association artificial dermis and negative pressure therapy: about two cases]. / Intérêt de l'association derme artificiel et thérapie par pression négative : à propos de deux cas.

In our modern health system, the improvement of the medical care cannot come along with an increase of expenses. In this purpose, we tried to bring to light the medical and economic, direct and indirect, benefits which exist with the association of an artificial dermis, Integra, and negative pressure therapy as the vacuum assisted closure (VAC) for wound which would have been treated by Integra alone. While preserving the aesthetic and functional qualities obtained by the artificial dermis alone followed by a skin graft after 21 days of treatment, the association of the negative pressure allows to perform the skin graft after only 10 days of treatment. This gain of time is a financial economy for the medical centers which have to shorten the durations of stay to be profitable. The patient benefits of a shorter hospitalization and will manage to return to work earlier. The quality of the treatment is not only improved by the absentia of immobilization of the patient but also by the decrease of the complications and the infectious risks due to the use of artificial dermis. The results so obtained highlight that in spite of the initial expense caused by this association the advantages are such that the use of the artificial dermis alone will not have interest any more.

[Primary cutaneous mucormycosis: a case report]. / Mucormycose cutanée primaire: à propos d'un cas.

The authors report the clinical history of a patient having presented a cutaneous mucormycosis at the waning of a traumatic dilapidation post of the left lower limb. Mucormycosis is an opportunistic fungal infection due to fungi of the group of mucorales present in the environment. There are various clinical forms of the disease; it occurs generally in a predisposed environment. The diagnosis is based on the mycologic and pathologic examination. The therapeutic approach must be multidisciplinary; the vital and functional prognosis depends on early diagnosis and treatment.

Sensation-seeking and emotional disturbances in depression: relationships and evolution.

The French abbreviated form of the sensation-seeking scale was given to 183 hospitalized depressed subjects meeting the DSM-III-R criteria for major depression. Depressed subjects, men and women, scored significantly lower than controls from the general population, paired as to age and sex, on all of the subscales. There was no relationship to the intensity of depression and anxiety. Relationships between emotional disturbances and sensation-seeking were differentiated according to the specificity of each subscale and to age and sex. There was no significant difference between baseline and after-treatment sensation-seeking scores and subjects at discharge still scored significantly lower than controls. Hypotheses on evolution at a later date after the hospitalization are made. The finding of positive relationships for some subjects between sensation-seeking and anhedonia is interpreted in regard to a compensatory process.

Early emotional disturbances during nicotine patch therapy in subjects with and without a history of depression.

BACKGROUND: The goal of this study was to compare development of emotional symptomatology during smoking cessation with transdermal nicotine patches in subjects with and without a history of depression. METHODS: Twenty-five subjects, 14 with a history of depression and 11 without such a history, were evaluated before beginning of cessation, on day 8, day 30, day 90 and day 120. RESULTS AND DISCUSSION: On day 120, ten subjects have maintained abstinence: 71.4% of subjects with and 45.5% of subjects without a history of depression relapsed. Both groups presented variable emotional symptomatology and there was no significant differences between subjects with and without a past depression. On the other hand, none of the symptoms which emerged during cessation predicted the issue of cessation. However, some symptoms appearing before beginning of cessation were related to subsequent relapse: lack of pleasure seeking and tiredness. Subsequent relapsers also tended to be more tense on baseline. These early symptoms can not be considered as withdrawal symptoms, they may reflect less confidence in success. It is also suggested that development of anhedonia represents an adaptative strategy to prepare for the withdrawal suffering.

Sensation seeking, nicotine dependence, and smoking motivation in female and male smokers.

Sensation-seeking scores in female (n = 36) and male (n = 60) French smokers were compared with those for a control group of female (n = 23) and male (n = 45) nonsmokers. The findings clearly show that smokers of both sexes are higher in sensation seeking than their nonsmoking counterparts: they score higher on the Disinhibition, Experience Seeking, and Boredom Susceptibility components of sensation seeking. Smoking women were particularly high on Experience Seeking. The relationships among the sensation-seeking components, nicotine dependence, and motives for smoking were assessed in the smokers. Disinhibition and Experience Seeking moderately correlated with nicotine dependence in females, as assessed by the Fagerström questionnaire and the Addictive factor of the Russell Classification of Smoking by Motives. Women high in Experience Seeking may be at particular risk for smoking and possibly for dependence. Further research is needed to state that the high sensation seeker is a person who might be expected to be particularly sensitive to the stimulating reward of smoking, and thus particularly vulnerable to becoming a dependent smoker.

Relationships between sensation seeking and emotional symptomatology during smoking cessation with nicotine patch therapy.

This study explored relationships between the sensation-seeking trait and the development of emotional symptomatology during smoking cessation with nicotine transdermal patches. Twenty-five subjects were evaluated before they stopped smoking, on Day 8, Day 30, Day 90, and Day 120. Initial motives for smoking and the sensation-seeking personality trait were tested as possible predictors for the development of specific mood disturbances. Our subjects scored very high on sensation seeking, consistent with previous results on smokers. This may also be due to the well-known tendency of high sensation-seekers to be willing to try new experiences. The sensation-seeking trait did not predict the issue of cessation. However, it was related to emotional deficit (anhedonia, affective blunting), tiredness, and a lack of energy, before and during smoking cessation. Two different interpretations of emotional deficit are proposed.

Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence.

The purpose of this study was to assess the test-retest stability of the Fagerstrom Tolerance Questionnaire (FTQ) in two samples: (a) paid subjects in an American laboratory; data were collected via telephone screen and subsequently via questions embedded in a written history; and (b) smokers hospitalized for depression in Paris; data were collected via a written questionnaire upon admission and again after 3 weeks of treatment for depression. Reliability data are also presented for a recently revised version of the FTQ, the Fagerstrom Test for Nicotine Dependence (FTND), and compared with FTQ data collected in a subsample of subjects in the American database who received both versions of the questionnaire. Both the FTQ (in both samples) and the FTND proved to be highly reliable. The validity of the scales, using cotinine, number of years smoked, and the "addictive" factor on the Classification of Smoking by Motives questionnaire as criterion variables, was also supported. No relationship between FTQ score and severity of depression was detected in either sample. Internal consistency was somewhat higher for the FTND than for the FTQ, replicating previous findings in the literature.

[Cystic mesothelioma of the peritoneum in a male]. / Mésothéliome kystique du péritoine chez un homme.

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.

[Sensation seeking and anhedonia in risk taking. Study of a population of bungy jumpers]. / Recherche de sensations et anhédonie dans les conduites de prise de risque. Etude d'une population de sauteurs à l'élastique (benji).

This study presents the investigation of the relations between sensation seeking (41) and anhedonia in 80 subjects who practice a risk taking sport, bengy jump. These relations were examined according to different variables which characterize the practice of bengy jump: the total number of previous jumps and the motivations to jump (1. personal motivation, 2. professional motivation--working in the jumping organization, and 3. group motivation--for example being leaded to jump by friends). We also assessed the use of psychoactive substances. All jumpers (men and women) have higher scores than control subjects in Thrill and adventure seeking dimension. In men, the more the subjects score on this dimension, the less they score on the physical anhedonia scale (8). In women, Experience Seeking and Boredom Susceptibility dimensions are positively correlated with physical anhedonia and with the number of jumps. Moreover, women with personal motivation are those who score the highest on Thrill and Adventure Seeking and Boredom Susceptibility dimensions. These results suggest that in women, sensation seeking through bengy jumping may be linked to a boredom tendency and driven by a need to compensate for a difficulty in experiencing emotions and sensations from common and mundane stimuli. In men, high frequency of bengy jumping was negatively related to the use of psychoactive substances, suggesting that bengy jump, in a compulsive form recalling an addictive behavior, is a specific and preferential way of stimulation seeking.

[French translation and validation of Izard's differential emotion scale. Study of the verbal qualification of emotions]. / Traduction et validation de l'échelle d'émotions différentielles d'Izard. Exploration de la qualification verbale des émotions.

This work presents the validation of a French version of the emotional self rating scale by Izard (Differential Emotion Scale). This scale is based on the theory of the Discrete Emotions which proposes the existence of ten fundamental emotions. This self-rating scale consists of thirty emotional adjectives (three for each emotion). The validation was done by using a non inductive method (by asking the subject to describe his present emotional state) with 84 control subjects. It shows that this version is valid. Main results are first the binarisation of the emotions (positive and negative), then the existence of complex factors with psychopathological meaning after factorial analysis. These results are in agreement with a theory of expressive emotional levels more than with the theory of discrete emotions in psychopathology.

[Sensation seeking and mood dimensions in depressive states]. / Recherche de sensations et dimensions de l'humeur dans les états dépressifs.

This study presents the investigation of the relations between dimensions of depressive mood and sensations seeking in 55 hospitalized depressed subjects. The concept of sensation seeking, identified by M. Zuckerman as a personality dimension, has been defined as the need for the subject to reach his optimal level of activation. The four subscores of sensation seeking, relatively independent, are identified in the sensation seeking scale; they stand at different levels on the dimensions of activation and pleasure which are emotional dimensions. These emotional dimensions are investigated in the exploration of the emotional components of depressive mood; the different symptomatic regroupings, such as blunted affect or impulsivity, do not have the same relations with these dimensions. The sensation seeking concept appears fruitful to investigate the different troubles of affective dynamic, which stand on the expressive and behavioral level, and on the subjective level. As in several studies with normal populations, we find again the same inverse relation between age and sensation seeking, and men obtain higher scores on the Thrill and Adventure seeking factor and on the Desinhibition factor. Globally, depressed subjects have lower scores of sensation seeking than normal subjects (paired by age and sex); but the weakness of sensation seeking is not proportional to the intensity of depression (Hamilton Depressive Scale) and to the the intensity of anxiety (Covi Brief Anxiety Scale). Interesting relations appear with the depressive mood factors, which agree with previous studies of sensation seeking in psychology and psychopathology.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated vasculitis of the spermatic cord]. / Vascularite isolée du cordon spermatique.

The authors report a case of isolated spermatic cord vasculitis associated with testicular infarct in a 75-year-old man. No clinical symptoms or serological markers of a systemic disease were found. This is a rare disease which cannot be diagnosed without histological examination and which requires follow-up because of a risk of progression to autoimmune disease.