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Background Aromatase inhibitors (AIs) are an established treatment modality for postmenopausal hormone-responsive breast cancer. Many of AI-treated patients experience AI-induced musculoskeletal syndrome (AIMSS), which may adversely affect quality of life and treatment adherence. The etiology underlying this syndrome remains unknown. Therefore, a well-established mouse model of human rheumatoid arthritis, collagen-induced arthritis (CIA), was used to evaluate how AIs affect bone and joints in inflammatory joint disease. Material and methods Thirty-two female DBA/1 mice were divided into 2 groups of 16 mice each; ovariectomy (OVX) or sham operation was performed at 7 weeks of age (=day 0). At day 14, arthritis was induced in all mice by injection of chicken sternal cartilage type II collagen emulsified with an equal volume of Freund's complete adjuvant, followed by a booster injection at day 21. Afterwards, mice were treated with letrozole or vehicle during 30 days. Mice were sacrificed at day 54. Parameters analyzed included clinical CIA score of paws, dual-energy x-ray absorptiometry, microCT of femora, histopathological examination of ankles and paws and IGF-I levels. Analysis was performed with ANOVA, post-hoc tests, general linearized and mixed models. Results As expected, OVX led to an increased lean and total body weight relative to the sham group. Repeated measurements analysis with mixed models suggested interaction between weight, time and arthritis severity. Serum IGF-I concentrations were significantly higher in the OVX group compared with the sham group, but no differences were observed between letrozole treatment and controls. Collagen immunization resulted in progressive inflammation of the paws including the ankles that increased up to day 54. Over time, clinical scores for arthritis severity were highest in the OVX/vehicle group. Both letrozole groups had an intermediate course and the lowest scores were seen in the paws of the sham/vehicle group, as expected. Histopathological examination of hematoxylin and eosin-stained sections were in line with these results. Subcapital BMD at the end of the arthritis experiments was significantly different between the four groups. Post-hoc test confirmed the negative effect of OVX versus sham procedure, in the presence or absence of letrozole treatment. MicroCT analysis showed that OVX induced a significant decrease in bone mineral density and content in both trabecular (volume and number) and cortical bone (volume, area, thickness and medullary area) compared to sham operation in vehicle-treated mice. In the letrozole group, only cortical bone (volume, area inside periost and medullary area) was significantly reduced following OVX. In addition, in the sham group, letrozole induced lower trabecular bone volume and less trabecular numbers compared to vehicle treatment. This was in contrast with the OVX groups; letrozole treatment resulted in significantly better trabecular bone parameters. Conclusion Not only bone loss but also severity of joint disease was increased by OVX. Remarkably, in contrast to what is observed in humans, letrozole treatment protected the bone and joints after OVX but had negative effects in its absence, thereby providing further evidence for a regulatory effect in joint and bone biology. [ABSTRACT FROM AUTHOR]

Background Molecular neuroimaging was applied in the quinpirole rat model for compulsive checking in OCD to visualize the D2- and mGluR5-receptor occupancy with Raclopride and ABP-688 microPET/CT. Methods Animals ( n = 48) were exposed to either saline (CTRL; 1 mL/kg) or quinpirole (QP; dopamine D2-agonist, 0.5 mg/kg) in a single injection (RAC and ABP acute groups) or twice-weekly during 7 weeks (chronic group). Animals underwent PET/CT after the 1st injection (acute) or before initial exposure and following the 10th injection in week 5 (chronic). For the latter, each injection was paired with an open field test and video tracking. Results The QP animals displayed a strong increase in visiting frequency (checking) in the chronic group (+ 699.29%) compared to the control animals. Acute administration of the drug caused significant ( p < 0.01) decreases in D2R occupancy in the CP (− 42.03% ± 4.01%). Chronical exposure resulted in significantly stronger decreases in the CP (− 52.29% ± 3.79%). Furthermore significant increases in mGluR5 occupancy were found in the CP (10.36% ± 4.09%), anterior cingulate cortex (13.26% ± 4.01%), amygdala (24.36% ± 6.86%), entorhinal cortex (18.49% ± 5.14%) and nucleus accumbens (13.8% ± 4.87%) of the chronic group, not present after acute exposure. Conclusions Compared to acute exposure, sensitisation to QP as a model for OCD differs both on a dopaminergic and glutamateric level, indicating involvement of processes such as receptor internalization and changes in extracellular availability of both neurotransmitters. [ABSTRACT FROM AUTHOR]

Robotic surgery is a significant technological innovation of the last 10 years. Although the advantages of robotic surgery for surgeons are obvious, robotic surgery must also demonstrate benefits for patients. We present current and future indications in oncological surgery and technological advances in medicine. Technological improvements and low cost will make this technique popular. Learning time is also shorter than for standard laparoscopy. The most obvious benefit is for the surgeon, with better ergonomics and probably a decrease of musculoskeletal diseases secondary to standard laparoscopy. [ABSTRACT FROM AUTHOR]

The article discusses a study which explores the impact of pelvic surgery for gynaecological cancer (GC) on the sexual and psychological functioning in women. It states that pelvic surgery for gynecological cancer may affect sexuality and lead to sexual dysfunction. Women who underwent gynecological surgery and from a control group completed questionnaires that evaluated their marital satisfaction, depression and sexual function. The study found that women with GC have reported sexual problems.

Objective: To describe effects of non‐ablative erbium‐doped:yttrium‐aluminium‐garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. Design: Animal experimental, randomised, sham and estrogen‐treatment controlled study with blinding for primary outcome. Setting: KU Leuven, Belgium. Sample: Twenty‐four ewes. Methods: Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1‐month interval; three sham manipulations with a 1‐month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. Main outcome measures: Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. Results: Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser‐treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen‐substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. Conclusions: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT. Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT. [ABSTRACT FROM AUTHOR]

Malgré les recommandations régulières émises par l'European Society for Medical Oncology (ESMO), la prise en charge des lésions des tissus mous est encore trop souvent insuffisante, pouvant aggraver le pronostic fonctionnel mais aussi vital du patient. Une étude a été menée au centre de référence de Lorraine. Tous Les patients inscrits dans la base de données NetSarc, au décours d'un passage en RCP, entre le 1er janvier 2010 et le 1er septembre 2016 ont été inclus. Les critères de conformité de prise en charge ont été établis en utilisant le dernier référentiel ESMO 2014, permettant de distinguer deux groupes, « conforme » et « non conforme » aux recommandations. Une première analyse comparative a été faite entre les deux groupes toutes lésions confondues. Puis une seconde uniquement sur les sarcomes. Au total, 445 patients présentant une lésion des tissus mous ont été inclus, 344 cas ont été traités selon les recommandations de l'ESMO, soit un taux de conformité de 77,3 %% (IC95 % : 73,4 %, 81,2 %). La conformité était meilleure pour le centre de référence que pour les structures périphériques (p < 0,001), avec des taux de conformité respectivement de 88,7 % et 51,6 %. Sur les 247 sarcomes, nous retrouvions un taux de résection R0 meilleur en cas de dossiers conformes 55 % contre 18 % (p < 0,001). Les taux de R1 étaient de 34 % contre 56 % et R2 de 11 contre 26 %. La survie n'était pas liée de manière significative à l'observance des recommandations dans l'analyse univariée. Après ajustement sur les facteurs pronostiques potentiels, en analyse multivariée, les résultats étaient similaires. Le respect des recommandations de l'ESMO, permet d'améliorer la qualité de l'exérèse chirurgicale des sarcomes et évite les gestes chirurgicaux inappropriés. Despite regular recommendations issued by the European Society for Medical Oncology (ESMO), patients faced still too often inadequate care with a direct influence on prognosis. A retrospective study was carried out at the Competence center in Lorraine Area. Patients registered in the NetSarc database between 1st, 2010 and September 1st, 2016 were included. Compliance criteria were established using the latest ESMO 2014 referential. Two groups "conforming" and "non conforming" were analyzed. A first analyze about all of the soft tissue lesion and a second only about sarcomas. In total, 445 patients were eligible, 344 cases were treated according to the ESMO guidelines, giving a 77.3% conformity rate (95% CI: 73.4%, 81.2%). Compliance was better for the competence center than district hospitals (P < 0.001), with compliance rates of 88.7%, and 51.6%, respectively. Among the 247 sarcomas, we found a R0 resection rate better according to the ESMO guideline, 55% against 18% (P < 0.001). R1 rates were 34% vs. 56% and R2 11 vs. 26% disease free survival was not related significantly to the observance of recommendations in the univariate analysis. After adjustment on potential DFS prognostic factors, in the multivariate analysis, the results were similar. Compliance with the ESMO guidelines, through appropriate management, improves the quality of surgical excision for sarcomas and avoids non-corresponding surgical gestures. [ABSTRACT FROM AUTHOR]

Motion tracking with finite time sampling causing an associated unknown residual motion between two motion measurements is one of the factors contributing to resolution loss in small animal PET motion correction. The aim of this work is (i) to provide a means to estimate the effect of the finite motion sampling on the spatial resolution of the motion correction reconstructions and (ii) to correct for this residual motion thereby minimizing resolution loss. We calculate a tailored spatially variant deconvolution kernel from the measured motion data which is then used to deconvolve the motion corrected image using a 3D Richardson-Lucy algorithm. A simulation experiment of numerical phantoms as well as a microDerenzo phantom experiment wherein the phantom was manually moved at different speeds was performed to assess the performance of our proposed method. In the motion corrected images of the microDerenzo phantom there was an average rod FWHM differences between the slow and fast motion cases of 9.7%. This difference was reduced to 5.8% after applying the residual motion deconvolution. In awake animal experiments, the proposed method can serve to mitigate the finite sampling factor degrading the spatial resolution as well as the resolution differences between fast-moving and slow-moving animals. Graphical abstract Motion correction of positron emission tomography (PET) scans of moving subjects can be performed by measuring the motion of the subject during the PET scan with an optical tracking camera. The motion tracking data obtained from the tracking camera is then used to correct the PET image reconstructions for motion. Due to finite time sampling of the motion data, the motion corrected reconstructions suffer from loss of spatial resolution. In the proposed method, a spatially variant deconvolution kernel is calculated from the motion tracking data, which is then used to correct the motion-corrected PET reconstructions for the blurring effect of the finite motion sampling through a Richardson-Lucy deconvolution. [ABSTRACT FROM AUTHOR]

Background Mastectomy with immediate breast reconstruction ( IBR) is a surgical strategy in breast cancer when breast-conserving surgery is not an option. There is a lack of evidence showing an advantage of mastectomy plus IBR over mastectomy alone on health-related quality of life ( QoL). Methods A large prospective multicentre survey, STIC-RMI (support of innovative and expensive techniques - immediate breast reconstruction), was undertaken to study the changes in QoL in patients treated by mastectomy with or without IBR. Patients were recruited between 2007 and 2009. European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 instruments were used to assess QoL before operation, and at 6 and 12 months after surgery. A propensity score was used to compare QoL between mastectomy alone and mastectomy plus IBR, with limited bias. Results A total of 595 patients were included from 22 French academic hospitals, of whom 407 (68·4 per cent) underwent IBR. One-year data were available for 71·1 per cent of patients. Factors associated with IBR were age, histological tumour type, palpable nodes and an attempt at breast-conserving surgery. At inclusion, QoL was significantly better in the IBR group ( P < 0·001) and there was no significant change in either group during 1 year compared with baseline. Results for the QLQ-BR23 functional dimension varied according to propensity score quartiles; IBR had no influence in the lowest quartile. In the upper quartiles, QoL increased slightly over the year among patients who had IBR, whereas it decreased among those who had mastectomy alone ( P = 0·037). Satisfaction with the cosmetic outcome strongly influenced QoL, especially in upper quartiles ( P < 0·001). However, an unsatisfactory outcome after IBR was still considered a better condition than simple mastectomy. Conclusion The QoL benefit provided by IBR depends on patients' life status at inclusion; young active women with an in situ tumour are more likely to preserve their QoL after IBR. [ABSTRACT FROM AUTHOR]

Background Aromatase inhibitor (AI) therapy is associated with musculoskeletal (MS) toxicity, which adversely affects quality of life and therapy adherence. Our objective was to evaluate whether genetic variants may predict endocrine therapy-related MS pain and hot flashes in a prospective observational cohort study. Patients & methods 254 early breast cancer patients starting AI (n = 159) or tamoxifen therapy (n = 95) were included in this genetic biomarker study. MS and vasomotor symptoms were assessed at baseline and after 3, 6 and 12 months of therapy. AI-induced MS pain was defined as an increase in arthralgia or myalgia relative to baseline. Single nucleotide polymorphisms (SNP) in candidate genes involved in oestrogen signalling or previously associated with AI-related MS pain or oestrogen levels were selected. Results Overall, 13 SNPs in CYP19 , CYP17 , osteoprotegerin ( OPG ) and oestrogen receptor 1 exhibited an allele frequency >0.05 and were included in the analysis. Patients carrying the G allele of rs2073618 in OPG experienced significantly more AI-induced MS toxicity compared to the wildtype allele, after correction for multiple testing ( P = 0.046). Furthermore, this SNP was associated with severity of pain ( P = 0.018). No association was found with regard to the other SNPs, both in AI and tamoxifen-treated patients. Neither could an association with vasomotor symptoms be demonstrated. Conclusion The SNP rs2073618 in OPG is associated with an increased risk of MS symptoms and pain with AI therapy, which has not been reported previously. Validation of this finding in larger cohorts and further functional studies are required. [ABSTRACT FROM AUTHOR]

Background Aromatase inhibitors (AIs) frequently lead to the AI-induced musculoskeletal syndrome (AIMSS). Looking into its pathophysiology, 6 months of AI therapy thickens the tendon sheath with intra-articular fluid (IAF) retention and loss of grip strength. We here report 24-month follow-up data. Patients and methods A prospective cohort study of 33 postmenopausal breast cancer patients received adjuvant endocrine therapy; 27 received an AI and 6 received tamoxifen. At baseline, 6 and 24 months patients had a rheumatologic examination, including a grip strength test, and magnetic resonance imaging of both hands and wrists. The primary end point was tenosynovial changes; secondary end points were changes in morning stiffness, grip strength and IAF. Results Twenty-three AI and 5 tamoxifen patients completed all investigations. Between month 6 and 24, IAF further increased in AI users (P = 0.04) but not in tamoxifen users, and grip strength further decreased in both groups. The worsened tenosynovial changes were strongly correlated with a decrease in grip strength. At 24 months, morning stiffness continued to be present in over a third of AI users. Conclusion AIMSS represents a substantial problem in breast cancer patients. It is associated with tenosynovial changes, IAF retention, joint stiffness and loss of grip strength that do not improve with prolonged use. [ABSTRACT FROM PUBLISHER]

Background: We studied the stellate ganglion block (SGB) recently suggested for the treatment of severe vasomotor symptoms and sleep disturbances in breast cancer survivors. Following an initial pilot study, which focused on the acceptability and safety of SGB for this important problem, we evaluated its short- and long-term efficacy. Materials and methods: Postmenopausal breast cancer survivors with severe vasomotor symptoms resistant to standard nonhormonal pharmacological intervention were eligible. Diaries were used to measure daily hot flash scores (frequency and intensity) and sleep quality (Pittsburgh Sleep Quality Index) during scheduled visits at baseline, 1, 4, 12 and 24 weeks following the SGB. Efficacy data were analyzed using longitudinal regression models. Results: Thirty-four patients participated and none refused the SGB procedure. Most patients received more than one SGB. The pilot study found SGB to be safe. In the main study, hot flash scores were reduced from baseline by 64% [95% confidence interval (CI) −74% to −49%] and 47% (95% CI −62% to −27%) at weeks 1 and 24, respectively. The odds ratio of better sleep quality relative to baseline was 3.4 at week 1 (95% CI 1.6–7.2) and 4.3 at week 24 (95% CI 1.9–9.8). Conclusion: In the short term, SGB appears to be an effective treatment with acceptable morbidity for some breast cancer survivors with therapy-resistant vasomotor symptoms and/or sleep disturbances. Although sleep quality was maintained out to 24 weeks the efficacy of SGB for hot flashes was reduced over time. A randomized controlled trial is needed to confirm these findings. [ABSTRACT FROM PUBLISHER]

Background: Our preliminary results showed that tenosynovial changes and decrease in grip strength are associated with the aromatase inhibitor-induced musculoskeletal syndrome (AIMSS). Here, we report the final results and assess the relationship between grip strength and body mass index (BMI).Patients and methods: We conducted a prospective study including postmenopausal early breast cancer patients receiving either an aromatase inhibitor (AI) or tamoxifen. Primary end point was change from baseline in tenosynovial abnormalities. Secondary end points were changes from baseline in morning stiffness, intra-articular fluid and grip strength and its association with BMI.Results: After 6 months of therapy, 74% [95% confidence interval (CI) 51% to 89%] of AI-treated patients had worsened tenosynovial abnormalities, 56% (95% CI 34% to 75%) had increased intra-articular fluid, and 22% (95% CI 9% to 45%) had increased morning stiffness. Grip strength decreased 8% for the left hand (95% CI 2% to 21%) and 11% for the right (95% CI 4% to 17%). Regression analysis suggested that grip strength decreased more for subjects with high or with low BMI.Conclusions: AIMSS is characterized by tenosynovial changes, intra-articular fluid and morning stiffness. We hypothesize that the quadratic association between BMI and loss of grip strength reflects AI-induced changes on the endocrine control of the growth hormone insulin-like growth factor-I pathway. [ABSTRACT FROM AUTHOR]

Abstract: Cryptosporidium parvum is a zoonotic protozoan parasite that may cause severe neonatal diarrhoea or even mortality in newborn ruminants: its oocysts are extremely resistant to normal environmental conditions and to most common disinfectants. KENO™COX, a patent pending amine-based formula, was tested for its ability to inactivate C. parvum oocysts. The Daugschies assay (2002), a standardized assay for chemical disinfection initially described for Eimeria spp., was adapted for C. parvum oocysts. KENO™COX diluted in water at 2% and 3% concentration and incubated with oocyst suspensions for 2h, allowed a significant reduction in viability, lysing 89% and 91% of oocysts respectively. Infectivity of the remaining C. parvum oocysts was assessed by inoculation to C57 Bl/6 neonatal mice. Each mouse received 2.5μl of a suspension initially containing 500,000 oocysts before contact with KENO™COX. Six days post inoculation, the intestinal parasite load was significantly reduced by 97.5% with KENO™COX 2% compared to that of the mice inoculated with untreated parasites. KENO™COX 3% completely eliminated infectivity of oocysts. The number of oocysts remaining infectious in the inoculum treated with KENO™COX 2% was calculated from an inoculated dose–response curve: it was estimated at about 48.6 oocysts among the 500,000 oocysts initially treated corresponding to 99.99% of inhibition. These results demonstrate the high efficacy of KENO™COX against C. parvum oocysts. Combined with an appropriate method of cleaning, the application of KENO™COX may be a useful tool to reduce cryptosporidial infectious load on farm level. [Copyright &y& Elsevier]

The article presents a study on the function of left ventricular size (LV) in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH) and the effect of endoluminal tracheal occlusion (FETO) on the fetal heart. It notes that 27 fetuses with isolated left-sided CDH were assessed to determine cardiac axis, LV diameters, ejection fraction, shortening fraction, mitral E/A index and myocardial performance index (MPI). CDH and FETO were found to have no impact in LV cardiac function.

The article presents a study which examines the validity of the myocardial performance index (MPI) in the assessment of fetal cardiac function in the second and third trimesters of gestation. The index was measured in relation to the systolic and diastolic indices of 117 healthy fetuses and 14 fetuses suspected for cardiac failure. It concludes that MPI is an indicator of the diastolic and systolic functions of fetal left ventricular valve.

Background: Telerobotic-assisted laparoscopic attempts to provide technological solutions to the inherent limitations of traditional laparoscopic surgery. The aim of this study is to report the first experience of two teams concerning telerobotic-assisted laparoscopic hysterectomy for benign and malignant pathologies.Methods: This study included 14 patients at the University Hospital Saint Pierre of Brussels (Belgium) and 16 patients at the Cancer Center of Nancy (France) from September 1999 to July 2003.Results: The indications for surgery were uterine malignant diseases in 12 cases (stade I) (41%), and benign pathologies of the uterus in 18 cases (59%). Five postoperative complications (17%) occurred, none related to the robotic system.Conclusion: Robotic surgery can be safely performed in gynecologic and gynecologic-oncologic surgery with no increase in complication rates. A significant advance is represented by the surgeon's ergonomic improvement. [ABSTRACT FROM AUTHOR]

The effects were compared of exercise in the fasted state and exercise with a high rate of carbohydrate intake on intramyocellular triglyceride (IMTG) and glycogen content of human muscle. Using a randomized crossover study design, nine young healthy volunteers participated in two experimental sessions with an interval of 3 weeks. In each session subjects performed 2 h of constant-load bicycle exercise (∼75%), followed by 4 h of controlled recovery. On one occasion they exercised after an overnight fast (F), and on the other (CHO) they received carbohydrates before (∼150 g) and during (1 g(kg bw)−1 h−1) exercise. In both conditions, subjects ingested 5 g carbohydrates per kg body weight during recovery. Fibre type-specific relative IMTG content was determined by Oil red O staining in needle biopsies from m. vastus lateralis before, immediately after and 4 h after exercise. During F but not during CHO, the exercise bout decreased IMTG content in type I fibres from 18± 2% to 6± 2% (P= 0.007) area lipid staining. Conversely, during recovery, IMTG in type I fibres decreased from 15± 2% to 10± 2% in CHO, but did not change in F. Neither exercise nor recovery changed IMTG in type IIa fibres in any experimental condition. Exercise-induced net glycogen breakdown was similar in F and CHO. However, compared with CHO (11.0± 7.8 mmol kg−1 h−1), mean rate of postexercise muscle glycogen resynthesis was 3-fold greater in F (32.9± 2.7 mmol kg−1 h−1,P= 0.01). Furthermore, oral glucose loading during recovery increased plasma insulin markedly more in F (+46.80μU ml−1) than in CHO (+14.63μU ml−1,P= 0.02). We conclude that IMTG breakdown during prolonged submaximal exercise in the fasted state takes place predominantly in type I fibres and that this breakdown is prevented in the CHO-fed state. Furthermore, facilitated glucose-induced insulin secretion may contribute to enhanced muscle glycogen resynthesis following exercise in the fasted state. [ABSTRACT FROM AUTHOR]

Purpose. – To retrospectively assess the efficacy of post-mastectomy re-irradiation for local relapse of breast cancer.Patients and methods. – Twenty patients, initially treated by conservative surgery and radiotherapy (50 Gy in 25 fractions over 5 weeks) were treated from 1998 to 2001 for a local relapse by salvage mastectomy and re-irradiation (either electron or photon beams). Mean age was 53 years (31–71). Reasons for re-irradiation were that the local relapses were inflammatory (4 pts), multifocal (5 pts), cutaneous (5 pts), involved the nipple (3 pts) or because the surgical margins (either muscle or skin) were involved (3 pts). The median dose of re-irradiation was 45 Gy (33–65) in 15 fractions over 33 days. Mean follow-up was 48 months (5–97).Results. – Fifteen patients remained free of a second local recurrence and 10 were still alive, without metastasis. Neither the dose of re-irradiation nor the irradiated surfaces were prognostic factors of local control (P = 0.877 and P = 0.424). Five patients developed radiation-induced pneumonitis without functional respiratory impairment. The incidence of pneumonitis seemed to be related to the biological dose of re-irradiation (P = 0.037). Other late complications occurred such as pigmentation changes (12 pts), telangiectasia (8 pts), chondritis (2 pts), parietal fibrosis (7 pts), rib fractures (4 pts), severe pain (11 pts) and lymphedema (2 pts). The increase in biological equivalent dose was highly statistically linked with the occurrence of disabling pain (P = 0.0123).Conclusion. – Parietal re-irradiation achieves good and lasting local control with an acceptable rate of acute complications but with a risk of disabling late sequelae such as severe pain. [Copyright &y& Elsevier]

Purpose. – Breast cancer rarely occurs in very young women, its diagnosis and management could sometimes be difficult. Our aim is to analyse the epidemiological and clinicopathological features of a group of very young women and especially to evaluate the results of therapeutic strategy.Methods. – We report a retrospective study conducted at the department of radiotherapy in Alexis-Vautrin Centre, concerning 30 patients aged ≤ 30 years in whom a diagnosis of invasive breast carcinoma was made between 1986 and 2001.Results. – Six patients had familial history of breast cancer. Palpable tumor was found in 90% of cases, the average size was 3.5 cm. Eleven patients presented with stage I, 11 presented with stage II, 6 presented with stage III and 2 presented with stage IV. Five cancers were diagnosed after pregnancy (average tumor size = 5.8 cm). Eleven patients received neoadjuvant chemotherapy and 23 (82%) of 28 operable cases of invasive malignancy underwent breast conservative surgery (BCS). We found an invasive ductal carcinoma with grade III in 13/27 cases and a nodal involvement in a half of cases, 11 patients of 26 had no expression of oestrogen receptor. The average follow-up was 5 years: six patients (20%) recurred locally (all of them were initially treated by BCS), four patients developed a contralateral breast cancer and three developed a second malignancy. Ten patients died of their metastatic disease. The 5-year overall survival rate was 78%.Conclusion. – Our results are consistent with those of the published reports and suggest that very young women with breast cancer have a poorer prognosis compared with the older ones. They should receive, according to their prognostic factors, an appropriate regional, systemic and hormonal therapy. [Copyright &y& Elsevier]

Résumé: Les tumeurs de la Granulosa de l’ovaire font partie des tumeurs rares de l’ovaire, du groupe des tumeurs des cordons sexuels et du stroma, hormono-sécrétantes. Dix-sept patientes, présentant une tumeur de la Granulosa de type adulte, étaient recensées entre 1995 et 2012. Toutes ont bénéficié d’une prise en charge chirurgicale première à un stade I. Trente-trois pour cent des patientes ont récidivé avec des nodules péritonéaux dans 68 % des cas, traitées chirurgicalement et parfois associées à des thérapeutiques complémentaires telles que : chimiothérapie, radiothérapie, hormonothérapie. La survie globale et sans récidive étaient respectivement de 100 % et 58,3 % à 10ans avec un délai médian de récidive de 6ans (4–27). Ces tumeurs sont donc de bon pronostic mais nécessitent une surveillance prolongée. Enfin, les facteurs pronostics de récidive identifiés dans la littérature sont le stade FIGO, la présence de tumeur résiduelle et la taille tumorale. [ABSTRACT FROM AUTHOR]

Abstract: The vagal nerve stimulation is approved for medically refractory epilepsy and major depression. We report the perioperative management of an epileptic patient with this indwelling device. This observation summarizes the physiologic implications and the specific anaesthetic considerations for procedures with this pre-existing device. [Copyright &y& Elsevier]

An abstract of the article "The Leuven Vulvalgesiometer: Improved Device to Measure Genital Pain-Pressure Thresholds in Clinical Practice and Research" by E. Pazmany et al. is presented.