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1. 21092. MEDIR LA CADENA LIGERA DE LOS NEUROFILAMENTOS MEJORA LA CAPACIDAD PREDICTIVA DE LOS SCORES DE RESPUESTA AL TRATAMIENTO EN ESCLEROSIS MÚLTIPLE

Author

V. Fernández, A. Pappolla, P. Carbonell Mirabent, M. Rodríguez Barranco, M. Castillo Juárez, L. Gutiérrez, N. Fissolo, H. Ariño Rodríguez, C. Auger, L. Bollo, J. Castilló Justribó, A. Cobo Calvo, C. Espejo Ruiz, I. Galán Cartaña, C. Guio Sánchez, D. Lapuma, L. Midaglia Fernández, N. Mongay Ochoa, C. Nos Llopis, S. Otero Romero, B. Rodríguez Acebedo, J. Sastre Garriga, P. Tagliani, C. Tur Gómez, A. Vidal Jordana, A. Vilaseca Jolonch, J. Villacieros Álvarez, A. Zabalza de Torres, A. Rovira Cañellas, M. Tintoré Subirana, M. Comabella López, J. Río Izquierdo, X. Montalban Gairín, and G. Arrambide

Subjects
Neurology. Diseases of the nervous system, RC346-429
Published
2024
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3. Tratamiento quirúrgico del cáncer de vulva

Author

H Tournat, M Deloménie, H Bonsang-Kitzis, Mikael Hivelin, Charlotte Ngo, H T Nguyen-Xuan, Fabrice Lecuru, A S Bats, C. Nos, Vincent Balaya, Meriem Koual, and M. A. Le Frere Belda

Abstract

Resumen El cancer de vulva, que afecta en la mayoria de los casos a mujeres de edad avanzada, es un cancer infrecuente, pero grave, debido a las caracteristicas de las pacientes en las que aparece. La cirugia es la piedra angular de su tratamiento y ha experimentado una reduccion de su morbilidad perioperatoria local y ganglionar con el desarrollo de la tecnica del ganglio centinela en los ultimos anos. El estatus ganglionar es un factor pronostico principal. El tratamiento quirurgico depende del estadio TNM (tumor, ganglios [node], metastasis). Para los estadios mayores a T1a, consiste en una vulvectomia radical, parcial o total, con el objetivo de obtener unos margenes de al menos 1 cm asociados a una evaluacion ganglionar sistematica. Por ultimo, los progresos de la radioterapia asociada a las tecnicas de quimiosensibilizacion permiten ofrecer alternativas terapeuticas aceptables a los estadios TNM mas avanzados.

Published
2021
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5. Faisabilité et résultats de l’hystérectomie prophylactique dans le syndrome de Lynch

Author

Léa Rossi, Fabrice Lecuru, Charlotte Ngo, Marie Gosset, A S Bats, C. Nos, M Deloménie, J. Pacelli, Pharmacologie, toxicologie et signalisation cellulaire (U747), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), and Université Paris Descartes - Paris 5 (UPD5)

Subjects
Gynecology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, business.industry, [SDV]Life Sciences [q-bio], Obstetrics and Gynecology, medicine.disease, Lynch syndrome, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, 030220 oncology & carcinogenesis, medicine, business
Abstract

Resume Objectifs Le syndrome de Lynch est une predisposition hereditaire aux cancers, en premier lieu desquels les cancers colo-rectaux et de l’endometre chez la femme. Bien que recommande, le depistage gynecologique n’a jamais fait la preuve de son benefice. La chirurgie prophylactique par hysterectomie totale non-conservatrice peut etre envisagee une fois le projet parental accompli. Actuellement, il existe peu de donnees concernant l’evaluation de cette chirurgie prophylactique dans ce contexte. Les objectifs de notre etude etaient d’evaluer la faisabilite et la morbidite de l’hysterectomie prophylactique chez les patientes presentant un syndrome de Lynch. Methodes Il s’agit d’une etude retrospective monocentrique descriptive portant sur les patientes consecutives beneficiant d’une chirurgie prophylactique gynecologique a l’Hopital Europeen Georges–Pompidou de 2002 a 2016. Nous avons recueilli les caracteristiques demographiques, les resultats du bilan preoperatoire, les donnees per et postoperatoires, les resultats anatomopathologiques definitifs ainsi que les donnees du suivi postoperatoires. Resultats Quarante patientes ont ete incluses, et 17 patientes avaient un antecedent de cancer colique opere. Toutes les hysterectomies ont ete realisees par coelioscopie, dont 2 cas de laparoconversion. Deux complications peroperatoires sont survenues: des plaies greliques sereuses et une plaie vesicale superficielle. Deux complications postoperatoires precoces sont survenues (une peritonite sur fistule grelique et une plaie ureterale gauche) et deux complications postoperatoires tardives (une fistule vesico vaginale et une occlusion sur bride). Avec un suivi median de 28 mois [5–52], aucune patiente n’a presente de cancer primitif peritoneal. Conclusion Notre etude montre que l’hysterectomie prophylactique dans le syndrome de Lynch doit etre realisee avec precaution. Les taux de complications per- et postoperatoires semblent plus eleves que dans la population generale, probablement en lien avec des antecedents de cancer colorectaux plus frequents. L’hysterectomie totale non-conservatrice semble cependant etre un moyen efficace de prevention des cancers gynecologiques chez les patientes presentant un syndrome de Lynch.

Published
2019
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6. Chirurgia locoregionale dei tumori al seno

Author

Chérazade Bensaid, Fabrice Lecuru, P. Capmas, A S Bats, Charlotte Ngo, C. Nos, and C Cornou

Subjects
03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, 030220 oncology & carcinogenesis
Abstract

Il tumore al seno e il primo tumore nelle donne in Francia e in tutto il mondo. La chirurgia e una parte essenziale del trattamento. Attraverso lo screening, circa il 60% dei tumori al seno e ora diagnosticato in una fase iniziale (T1-T2N0). Lo sviluppo di trattamenti diversificati del tumore al seno ha permesso un’evoluzione chirurgica. Pertanto, il 70% dei tumori al seno invasivi e trattato con una chirurgia conservativa del seno, la tumorectomia (o mastectomia parziale), e con un trattamento “conservativo” dell’ascella: la tecnica del linfonodo sentinella, che e divenuta, nell’ultimo decennio, lo standard nella valutazione dello stato linfonodale in queste fasi. Inoltre, la chemioterapia neoadiuvante e le tecniche di oncoplastica hanno permesso di aumentare il tasso di conservazione del seno, tanto che la mastectomia radicale modificata, descritta da Madden nel 1972, che comprende una mastectomia totale e una dissecazione ascellare infra- e retropettorale, e ormai poco indicata. Anche la dissecazione ascellare e controversa e, se persiste ancora qualche indicazione ben nota, il prossimo decennio vedra probabilmente la sua fine. Sono di seguito descritte le tecniche di tumorectomia, mastectomia totale, tecnica del linfonodo sentinella e dissecazione ascellare.

Published
2017
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7. Tratamiento quirúrgico de los tumores benignos del ovario (excluidos endometriomas)

Author

P Capmas, C Cornou, A S Bats, Charlotte Ngo, Chérazade Bensaid, Fabrice Lecuru, and C. Nos

Subjects
03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, 030220 oncology & carcinogenesis
Abstract

Los tumores de ovarios probablemente benignos (TOPB) son un motivo frecuente de consulta en ginecologia. El estudio previo al tratamiento debe incluir como minimo una ecografia pelvica. Esta ultima es esencial para distinguir entre los tumores organicos presuntamente benignos y los tumores con alto riesgo de malignidad. Tras la ecografia, en caso de duda diagnostica, se puede solicitar una determinacion de los concentraciones de marcadores tumorales y un estudio con resonancia magnetica (RM) pelvica. Tambien se puede repetir la ecografia pelvica, en particular en caso de sospecha de quiste funcional. El tratamiento es quirurgico si el quiste es organico o persistente; el resultado patologico con mas frecuencia va a favor de un cistoadenoma seroso, mucinoso o un teratoma maduro. En la mayoria de los casos se realiza mediante laparoscopia. Independientemente de la via de acceso, el primer tiempo de la intervencion quirurgica consta de una exploracion abdominopelvica completa, asi como de una citologia peritoneal. En las mujeres en edad fertil se realiza principalmente una quistectomia, y en las mujeres posmenopausicas, una anexectomia bilateral. En las pacientes premenopausicas sin deseos de fertilidad (a menudo entre los 40-50 anos) se puede proponer una anexectomia unilateral o en caso de quiste voluminoso (superior a 15 cm) que haga el tratamiento conservador dificil y probablemente poco beneficioso (el ovario a menudo resulta lesionado durante el procedimiento).

Published
2017
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8. What about sentinel lymph node biopsy for early breast cancer during pregnancy?

Author

Myriam Mimouni, P.M. David, C. Nos, M Deloménie, A S Bats, Vincent Balaya, Fabrice Lecuru, Marie Gosset, H Bonsang-Kitzis, and Charlotte Ngo

Subjects
Adult, medicine.medical_specialty, Sentinel lymph node, Breast Neoplasms, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Pregnancy, Biopsy, medicine, Humans, 030212 general & internal medicine, Radionuclide Imaging, Lymph node, Pathological, Early breast cancer, Fetus, medicine.diagnostic_test, Sentinel Lymph Node Biopsy, business.industry, Obstetrics and Gynecology, medicine.disease, Technetium Compounds, medicine.anatomical_structure, Reproductive Medicine, 030220 oncology & carcinogenesis, Female, Radiology, Radiopharmaceuticals, business, Pregnancy Complications, Neoplastic
Abstract

Pregnancy-associated breast cancer is rare, but this clinical situation arises in 1/10,000-1/3000 pregnancies. In patients presenting an early-stage breast tumor devoid of clinically pathological lymph node, sentinel lymph node (SLN) biopsy has not yet been validated as a routine procedure for pregnant women due to the lack of data in the literature. The blue dye injection is not recommended because of 2% theoretical risk of anaphylactic shock. Several studies have shown that Tc99m injection at conventional dose between 12.1 and 18.5MBq exposed the fetus to an irradiation between 0.011 and 0.0245mSv much below the 50mSv recommended threshold. As evidenced by lymphoscintigraphy scans, the dose of injected Tc99m is localized at the injection site and in the SLN. According to the literature, the SLN technique does not seem to impact the fetal or obstetrical prognosis. Studies involving larger cohorts are required to confirm these data and to indicate this technique in pregnant women. Considering the benefit for the patient and the low risk incurred on both fetal and obstetrical levels, it appears reasonable to discuss the indication of SLN on a case-by-case basis in multidisciplinary oncologic meetings.

Published
2018
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9. Aportación del robot en cirugía endoscópica

Author

Julien Seror, Fabrice Lecuru, A S Bats, N Douay-Hauser, Charlotte Ngo, Chérazade Bensaid, and C. Nos

Subjects
03 medical and health sciences, 030219 obstetrics & reproductive medicine, 0302 clinical medicine, 030220 oncology & carcinogenesis
Abstract

El desarrollo de la cirugia minimamente invasiva, y mas particularmente de la laparoscopia desde la decada de 1980, ha permitido realizar un avance significativo en la cirugia ginecologica, tanto para enfermedades benignas como malignas. Las ventajas de la cirugia laparoscopica estan reconocidas desde hace muchos anos: disminucion de la hemorragia postoperatoria, reduccion del dolor postoperatorio, disminucion de la hospitalizacion, convalecencia mas rapida con reanudacion mas precoz de la actividad y ventajas esteticas. Sin embargo, el desarrollo de la laparoscopia no ha sido uniforme y esta tecnica se emplea demasiado poco en la actualidad en comparacion con la laparotomia, debido a su dificultad y a su curva de aprendizaje demasiado larga, quedando limitada a los centros y cirujanos con gran experiencia. La cirugia asistida por robot, que esta actualmente en pleno auge, esta en vias de convertirse en la alternativa a la laparoscopia y la laparotomia en el ambito de la cirugia ginecologica. Sus ventajas principales son la vision tridimensional, una exposicion controlada por el cirujano, una mayor ergonomia que permite disminuir la fatiga y aumentar la precision del cirujano, asi como una curva de aprendizaje mas corta que para la laparoscopia simple. Debido a que esta es una tecnica reciente, los datos de la literatura son numerosos, pero de calidad discutible por el momento, dada la falta de ensayos prospectivos y aleatorizados. Sin embargo, esta cirugia presenta varios inconvenientes: tamano y aparatosidad del robot, tiempo de instalacion, coste. Por tanto, esto implica la necesidad de sopesar bien las indicaciones de la laparoscopia asistida por robot, para equilibrar el balance beneficios/coste/organizacion. En este articulo, se analiza la aportacion de la cirugia asistida por robot en ginecologia, tanto en patologias benignas como malignas.

Published
2016
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10. Upper outer boundaries of the axillary dissection. Result of the SENTIBRAS protocol: Multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection

Author

C. Nos, S. Lasry, S. Giard, B. Flipo, J-M Classe, H. Charitansky, Anne-Sophie Bats, G. Le Bouedec, P. Bonnier, M.-C. Missana, Virginie Doridot, Charlotte Ngo, Krishna B. Clough, and A. Charles-Nelson

Subjects
Adult, medicine.medical_specialty, Breast Cancer Lymphedema, Antineoplastic Agents, Breast Neoplasms, 030230 surgery, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Breast cancer, Clinical Protocols, Biopsy, medicine, Humans, Aged, medicine.diagnostic_test, Sentinel Lymph Node Biopsy, business.industry, Axillary Lymph Node Dissection, General Medicine, Middle Aged, Sentinel node, medicine.disease, Neoadjuvant Therapy, Surgery, Axilla, Lymphedema, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Feasibility Studies, Lymph Node Excision, Female, Lymph Nodes, Lymph, Sentinel Lymph Node, business, Lateral thoracic vein
Abstract

Two thirds of node-positive breast cancer patients have limited pN1 disease and could benefit from a less extensive axillary lymph node dissection (ALND).172 breast cancers patients requiring an ALND were prospectively enrolled in the Sentibras Protocol of Axillary Reverse Mapping (ARM). Radioisotope was injected in the ipsilateral hand the day before surgery. ALND was standard. Removed lymph nodes were classified into non radioactive nodes and radioactive nodes (ARM nodes). Among ARM nodes, nodes located in the upper outer part of the axilla, above the second intercostal brachial nerve and lateral to the lateral thoracic vein were identified as "zone D ARM nodes". The main objective was: feasibility of identification of the zone D ARM nodes. Secondary objectives were: metastatic involvement and lymphedema rate.100% of patients had ARM nodes identified. The "zone D ARM nodes" were identified in 92% of cases. The rate of metastatic nodes was 60% in the all cohort, 31% in ARM nodes and 9% in zone D ARM nodes. Among those, metastatic rate was 6% in patients undergoing ALND for a positive sentinel node biopsy, 6% in case of primary ALND versus 14% after neo-adjuvant chemotherapy (p 0.05). After 34 months of median follow up, 27% of interviewed patients had a lymphedema.The ARM technique reliably identifies the "zone D ARM nodes". These nodes can also easily be identified using knowledge of axillary anatomy. In selected patients, a selective ALND sparing the zone D ARM nodes could be performed.

Published
2016
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11. Ganglion sentinelle et curage axillaire dans le cancer du sein : la pratique française face aux recommandations à l’ère post-2011

Author

P. Capmas, Charlotte Ngo, A. Clavier, C Cornou, C. Nos, Fabrice Lecuru, Chérazade Bensaid, and A S Bats

Subjects
Gynecology, medicine.medical_specialty, Lymphatic metastasis, 030219 obstetrics & reproductive medicine, business.industry, Sentinel lymph node, Obstetrics and Gynecology, General Medicine, 03 medical and health sciences, 0302 clinical medicine, Reproductive Medicine, 030220 oncology & carcinogenesis, medicine, business
Abstract

Resume But Aujourd’hui, les recommandations francaises et internationales different concernant la prise en charge du creux axillaire en cas de ganglion sentinelle (GS) metastatique dans le cancer du sein. Nous avons realise une enquete sur les pratiques francaises. Materiels et methodes Un questionnaire a ete envoye a 454 chirurgiens senologues entre juin 2014 et janvier 2015. Ce questionnaire comprenait des items sur : les indications de la biopsie du GS, la frequence du curage axillaire (CA) en cas de GS metastatique et les modalites de la radiotherapie en cas de GS metastatique sans CA. Resultats Au total, 169 chirurgiens (37 %) ont repondu au questionnaire. Vingt et un pour cent des chirurgiens ne font pas de CA en cas de macrometastase. Trente-deux pour cent ne font pas d’examen extemporane du GS. De plus, 8,4 % des praticiens realisent une biopsie du GS apres chimiotherapie neoadjuvante et 14 % dans le cas de tumeurs multicentriques, alors que cette derniere indication n’est pas recommandee. Dans le cas d’un GS metastatique sans CA complementaire, les champs d’irradiation sont etendus a l’aisselle dans 44 % des cas. Conclusion Des discordances significatives sont observees entre les pratiques et les recommandations nationales. La divergence entre les recommandations francaises et internationales conduit a des pratiques chirurgicales heterogenes.

Published
2016
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12. Shorter infusion time of ocrelizumab: Results from the randomized, double-blind ENSEMBLE PLUS substudy in patients with relapsing-remitting multiple sclerosis

Author

Regine Buffels, M. Garas, Robert A. Bermel, H.-P. Hartung, K. Kadner, Rana Karabudak, Bruno Brochet, Thomas Berger, A. Perrin Ross, William M. Carroll, Joep Killestein, Marianna Manfrini, C. Nos, Ludo Vanopdenbosch, Francesco Patti, Trygve Holmøy, Mark S. Freedman, Timothy Vollmer, Qing Wang, Neurology, AII - Inflammatory diseases, and Amsterdam Neuroscience - Neuroinfection & -inflammation

Subjects
Multiple Sclerosis, Antibodies, Monoclonal, Humanized, relapsing-remitting multiple sclerosis, Article, Double blind, 03 medical and health sciences, Multiple Sclerosis, Relapsing-Remitting, 0302 clinical medicine, Clinical endpoint, medicine, Humans, Immunologic Factors, In patient, Ocrelizumab, 030212 general & internal medicine, Adverse effect, business.industry, Infusion time, Multiple sclerosis, infusion-related reaction, General Medicine, medicine.disease, Neurology, Relapsing remitting, shorter infusion, Anesthesia, Neurology (clinical), business, 030217 neurology & neurosurgery, medicine.drug
Abstract

Highlights • Infusion-related reaction rates were similar in shorter and conventional infusions • The majority of infusion-related reactions were mild to moderate • No infusion-related reactions were serious, life-threatening or fatal • No new safety signals were observed with a shorter infusion time • Shortening the infusion time may lessen the burden on patients and site staff, Background: Ocrelizumab is an approved intravenously administered anti-CD20 antibody for multiple sclerosis (MS). Shortening the 600 mg infusion to 2 hours reduces the total site stay from 5.5–6 hours (approved infusion duration including mandatory pre-medication and post-infusion observation) to 4 hours. The safety profile of shorter-duration ocrelizumab infusions was investigated using results from ENSEMBLE PLUS. Methods: ENSEMBLE PLUS is a randomized, double-blind substudy to the single-arm ENSEMBLE study (NCT03085810). In ENSEMBLE, patients with early-stage relapsing-remitting MS received ocrelizumab 600 mg infusions every 24 weeks for 192 weeks. In ENSEMBLE PLUS, ocrelizumab 600 mg administered over the approved 3.5-hour infusion time (conventional duration) is compared with a 2-hour infusion (shorter duration); the durations of the initial infusions (2×300 mg, 14 days apart) were unaffected. The primary endpoint was the proportion of patients with infusion-related reactions (IRRs) following the first Randomized Dose. Results: From November 1, 2018, to December 13, 2019, 745 patients were randomized 1:1 to the conventional or shorter infusion group. At the first Randomized Dose, 99/373 patients (26.5%) in the conventional and 107/372 patients (28.8%) in the shorter infusion group experienced IRRs. The majority of IRRs were mild or moderate; >99% of all IRRs resolved without sequelae in both groups (conventional infusion group, 99/99; shorter infusion group, 106/107). No IRRs were serious, life-threatening, or fatal. No IRR-related discontinuations occurred. During the first Randomized Dose, 22/373 (5.9%) and 39/372 (10.5%) patients in the conventional and shorter infusion groups, respectively, had IRRs leading to infusion slowing/interruption. Adverse events were consistent with the known safety profile of ocrelizumab. Conclusion: The rates and severity of IRRs were similar between conventional and shorter infusions. No new safety signals were detected. Shortening the infusion time to 2 hours reduces the total site stay time (including mandatory pre-medication/infusion/observation) from 5.5–6 hours to 4 hours, and may reduce patient and site staff burden.

Published
2020
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13. [Prophylactic hysterectomy in Lynch syndrome: Feasibility and outcomes]

Author

J, Pacelli, M, Gosset, L, Rossi, C, Ngo, M, Delomenie, C, Nos, F, Lécuru, and A-S, Bats

Subjects
Salpingo-oophorectomy, Prophylactic Surgical Procedures, Middle Aged, Hysterectomy, Colorectal Neoplasms, Hereditary Nonpolyposis, Endometrial Neoplasms, Postoperative Complications, Feasibility Studies, Humans, Female, Genetic Predisposition to Disease, Laparoscopy, Colorectal Neoplasms, Intraoperative Complications, Retrospective Studies
Abstract

Lynch syndrome (LS) is a hereditary predisposition to cancers, first of all, colo-rectal and endometrial cancers in women. Although recommended, gynecologic screening has never proven its benefit. Prophylactic surgery can be considered once the parental project is completed. There are few data regarding the assessment of prophylactic surgery. The objectives of our study were to evaluate the feasibility and morbidity of prophylactic hysterectomy in patients with Lynch syndrome.This is a descriptive retrospective study of consecutive patients with LS undergoing prophylactic hysterectomy at the Georges-Pompidou European Hospital from 2002 to 2016. We collected demographic characteristics, results of preoperative assessment, intra- and postoperative data, final pathologic result as well as postoperative follow-up data.Forty patients were included in the study, and seventeen women had a history of colon cancer surgery. All hysterectomies were performed by laparoscopy, with two cases of laparoconversion. Two intraoperative complications occurred: serosal small bowel injuries and superficial bladder injury. Two early postoperative complications occurred (a peritonitis on small bowel perforation and a peritonitis on left ureteral injury) and two late complications (vesico-vaginal fistula and adhesive small bowel obstruction). All operative specimens were benign. With a median follow-up of 28 months [5-52], no patient had peritoneal cancer.Our study shows that prophylactic hysterectomy in Lynch syndrome should be done with caution. Per and postoperative complication rates appear to be higher than in general population, probably related to a more frequent history of colorectal cancer. However, total hysterectomy with bilateral salpingo-oophorectomy appears to be an effective strategy for preventing gynecological cancers in women with the Lynch syndrome.

Published
2018

14. Linfadenectomías en el cáncer de endometrio

Author

C. Nos, Fabrice Lecuru, A S Bats, A Achouri, Chérazade Bensaid, Charlotte Ngo, and L Makke

Abstract

El cancer de endometrio es el cancer ginecologico mas frecuente. La indicacion de linfadenectomias se ha modificado en los ultimos anos. Sistematicos, pelvicos y en ocasiones extendidos a la region aorticocava, los vaciamientos ganglionares se deciden en funcion de parametros histologicos que definen grupos de riesgo (asi como la operabilidad de la paciente). Los vaciamientos ya no se recomiendan para las pacientes en las que el riesgo metastasico ganglionar se considera bajo o intermedio. En dos ensayos terapeuticos, en los que se incluyo en su mayoria a este tipo de pacientes, los vaciamientos pelvicos no demostraron ningun beneficio. La tecnica del ganglio centinela, que permite una extirpacion quirurgica ganglionar dirigida con muy buena sensibilidad, probablemente sea una alternativa interesante para estas pacientes. Por el contrario, para las pacientes de alto riesgo se propone un vaciamiento aorticocava y en ocasiones pelvico, con la condicion de que el estado general lo permita y que el resultado tenga una repercusion en los tratamientos adyuvantes. Esta desescalada terapeutica es paralela a la evolucion de las indicaciones de radioterapia postoperatoria.

Published
2015
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15. Surgery for ovarian cancer: Main principles still valid

Author

Eric Pujade-Lauraine, C. Nos, Jacques Medioni, Julien Seror, N Douay-Hauser, Charlotte Ngo, Chérazade Bensaid, A S Bats, Fabrice Lecuru, and Pierre Combe

Subjects
Oncology
Abstract

Le cancer de l’ovaire est la premiere cause de mortalite par cancer gynecologique. La chirurgie est avec la chimiotherapie la base du traitement. La resection complete des lesions est l’objectif de la chirurgie qu’elle soit faite au debut du traitement ou apres quelques cycles de chimiotherapie. La selection des patientes entre chirurgie immediate ou differee est la seule question incompletement resolue. Les sites qui prennent en charge ces patientes et leur parcours de soins semblent au moins aussi importants que la qualite de l’acte chirurgical proprement dit.

Published
2014
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16. Ganglion sentinelle dans les cancers du col de faible stade. Données actuelles. Assurance qualité. Perspectives

Author

C. Nos, Anne-Sophie Bats, Julien Seror, Patrice Mathevet, Fabrice Lecuru, Nathalie Douay Hauser, and Chérazade Bensaid

Subjects
Gynecology, Cancer Research, medicine.medical_specialty, education.field_of_study, medicine.diagnostic_test, business.industry, Nodal metastasis, medicine.medical_treatment, Population, Hematology, General Medicine, Sentinel node, Nodal disease, Oncology, Biopsy, medicine, Radiology, Nuclear Medicine and imaging, Lymphadenectomy, education, business
Abstract

Sentinel node biopsy appears as a promising technique for the assessment of nodal disease in early cervical cancers. Selection of a population with a low risk of nodal metastasis, a minimal training, and simple rules allow a low false negative rate. Sentinel node biopsy provides supplementary information, such as anatomical information (nodes outside of routine lymphadenectomy areas) and histological information (isolated tumors cells and micrometastases).

Published
2014
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17. Tecnica e risultati del prelievo del linfonodo sentinella nei cancri del collo e del corpo dell’utero

Author

M. A. Le Frère-Belda, Chérazade Bensaid, Fabrice Lecuru, A Achouri, Marc Faraggi, A S Bats, C. Nos, and Patrice Mathevet

Abstract

La biopsia del linfonodo sentinella e una metodica diagnostica che permette il prelievo linfonodale mirato delle prime stazioni linfonodali di un tumore, rappresentativo dei linfonodi a valle. Questa tecnica si sviluppa da una decina di anni nei cancri dell’utero, per i quali lo status linfonodale e un fattore prognostico principale. I suoi obiettivi principali sono di ridurre la morbilita degli svuotamenti completi, di individuare dei territori di drenaggio inattesi e, anche, di realizzare un’ultrastadiazione linfonodale. La tecnica di rilevamento combinata, con coloranti e isotopi, e quella che apporta i migliori risultati in termini di tasso di individuazione. I dati della letteratura sulla biopsia del linfonodo sentinella nei cancri del collo precoci hanno dimostrato ampiamente la sua fattibilita. I tassi di individuazione sono molto buoni, come anche il suo valore diagnostico. La tecnica permette di realizzare un’ultrastadiazione linfonodale evidenziando delle micrometastasi. Il prelievo del linfonodo sentinella e realizzabile anche nei cancri dell’endometrio, con, tuttavia, dei tassi di individuazione e di falsi negativi molto variabili secondo le casistiche, influenzati soprattutto dalla via di iniezione. Se l’iniezione intratumorale, realizzata soprattutto mediante isteroscopia, e quella che permette di evidenziare meglio il vero drenaggio linfatico del tumore, la sua attuazione e, tuttavia, assai poco riproducibile.

Published
2013
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18. Pre-operative imaging of initial and locoregional lymph node area in breast cancer

Author

E. Aubert, C. Nos, and C. Ala Eddine-Le Jallé

Subjects
Oncology
Abstract

L’extension ganglionnaire doit etre recherchee attentivement en pretherapeutique afin de guider la therapeutique, notamment le geste chirurgical axillaire qui sera parfois realise apres une chimiotherapie neoadjuvante source de sousestimation. L’echographie joue un role central dans ce bilan, car les sondes de haute resolution permettent de rechercher des implants metastatiques de plus de 3 mm, et les techniques de ponction peuvent authentifier cette atteinte dans pres de 80 a 90 % des cas. Demontrer en preoperatoire la diffusion ganglionnaire permettra au chirurgien de se passer de l’exploration par technique du ganglion sentinelle (GS) qui necessite un equipement couteux et une equipe entrainee. Lorsque la diffusion ganglionnaire est prouvee ou fortement suspectee, les techniques d’imagerie en coupe (tomodensitometrie et/ou imagerie par resonancemagnetique) permettent de quantifier cette extension afin de guider l’etendue du geste chirurgical et le volume des champs de radiotherapie. La tomographie par emission de positons se developpe et peut aussi aider au staging ganglionnaire. Aucune technique n’a une valeur predictive negative suffisamment elevee pour se passer d’une exploration chirurgicale, mais la technique du GS doit etre reservee aux patients consideres comme N0 clinique et radiologique apres etude echographique attentive. Les apports attendus et les limites actuelles des techniques d’imagerie seront developpes.

Published
2013
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19. Técnica y resultados de la biopsia del ganglio centinela en los cánceres del cuello y del cuerpo uterinos

Author

Marc Faraggi, A Achouri, Patrice Mathevet, A S Bats, Chérazade Bensaid, M. A. Le Frère-Belda, C. Nos, and Fabrice Lecuru

Abstract

La biopsia del ganglio centinela es un metodo diagnostico que permite la extirpacion dirigida de las primeras invasiones ganglionares de un tumor, una muestra que es representativa de los ganglios subsiguientes. Esta tecnica se esta desarrollando desde hace unos 10 anos con relacion a los canceres del utero, en los cuales el estado ganglionar es un factor pronostico principal. Sus objetivos principales son limitar la morbilidad de los vaciamientos ganglionares completos, detectar territorios de drenaje inesperados y efectuar una ultraestadificacion ganglionar. La tecnica de deteccion combinada, por tincion e isotopica, produce los mejores resultados en cuanto a indices de deteccion. Los datos de las publicaciones sobre la biopsia precoz del ganglio centinela en los canceres del cuello uterino confirman ampliamente la utilidad de esta practica. Los indices de deteccion y el valor diagnostico son muy buenos. La tecnica hace posible una ultraestadificacion ganglionar para demostrar micrometastasis. La biopsia del ganglio centinela tambien es factible en los canceres de endometrio, pero los indices de deteccion y de falsos negativos varian mucho segun las series, principalmente en relacion con la via de inyeccion. Aunque la inyeccion intratumoral por histeroscopia es la que permite demostrar mejor el verdadero drenaje linfatico del tumor, su realizacion es bastante poco reproducible.

Published
2013
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21. Diagnostic performance of one-step nucleic acid amplification for intraoperative sentinel node metastasis detection in breast cancer patients

Author

Jean Cuisenier, Hubert Crouet, François Guillemin, Catherine Bouteille, Fabrice Lecuru, Pierre Seffert, Laurent Arnould, Gilles Chatellier, Cécile Blanc-Fournier, Agnès Leroux, Michel Peoc'h, Bruno Poulet, G. Houvenaeghel, Frédérique Penault-Llorca, Pierre Gimbergues, C. Nos, Florence Gillaizeau, Anne-Sophie Bats, Krishna B. Clough, Marie-Aude Le Frère-Belda, Jocelyne Jacquemier, Hopitaux de Paris, Université Paris Descartes - Paris 5 ( UPD5 ), Institut Curie, Service d'Anatomie pathologique, Centre hospitalier Universitaire, Centre Alexis Vautrin ( CAV ), Centre de Recherche en Automatique de Nancy ( CRAN ), Université Henri Poincaré - Nancy 1 ( UHP ) -Institut National Polytechnique de Lorraine ( INPL ) -Centre National de la Recherche Scientifique ( CNRS ), Département de Biologie et pathologie des tumeurs [Centre Georges-François Leclerc], Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc ( CRLCC - CGFL ), Centre Jean Perrin, CRLCC Jean Perrin, Département de biopathologie, Centre de Recherche en Cancérologie de Marseille ( CRCM ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université ( AMU ), Département de chirurgie Paoli Calmette ( Paoli Calmette ), Université Paris Descartes - Paris 5 (UPD5), Centre Alexis Vautrin (CAV), Centre de Recherche en Automatique de Nancy (CRAN), Université Henri Poincaré - Nancy 1 (UHP)-Institut National Polytechnique de Lorraine (INPL)-Centre National de la Recherche Scientifique (CNRS), Centre Régional de Lutte contre le cancer - Centre Georges-François Leclerc (CRLCC - CGFL), Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), Département de chirurgie Paoli Calmette (Paoli Calmette), Institut Curie [Paris], Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER, Centre Jean Perrin [Clermont-Ferrand] (UNICANCER/CJP), UNICANCER, Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, [ SDV.BBM.BP ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biophysics, Cancer Research, Pathology, medicine.medical_specialty, Sentinel lymph node, Breast Neoplasms, Sensitivity and Specificity, Likelihood ratios in diagnostic testing, Metastasis, Intraoperative Period, 03 medical and health sciences, breast cancer, 0302 clinical medicine, Breast cancer, medicine, Humans, cytokeratin 19, Lymph node, Aged, 030304 developmental biology, Aged, 80 and over, Keratin-19, 0303 health sciences, Sentinel Lymph Node Biopsy, business.industry, Micrometastasis, Intraoperative molecular analysis, Cancer, Middle Aged, medicine.disease, 3. Good health, [SDV.BBM.BP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biophysics, medicine.anatomical_structure, Oncology, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Axilla, sentinel lymph node metastasis, Female, Breast disease, Radiology, business, Nucleic Acid Amplification Techniques
Abstract

International audience; The purpose of this prospective multicenter study was to assess one-step nucleic acid amplification (OSNA) for intraoperative sentinel lymph node (SLN) metastasis detection in breast cancer patients, using final histology as the reference standard. OSNA results were also compared to intraoperative histology SLN evaluation and to standard clinicopathological risk markers. For this study, fresh SLNs were cut in four blocks, and alternate blocks were used for OSNA and histology. CK19 mRNA copy number was categorized as strongly positive, positive, or negative. Positive histology was defined as presence of macrometastasis or micrometastasis. When discrepancies occurred, the entire SLNs were subjected to histological studies and the node lysates to additional molecular studies. Five hundred and three SLN samples from 233 patients were studied. Mean time to evaluate two SLNs was 40 minutes. Sensitivity per patient was 91.4% (95%CI, 76.9%-98.2%), specificity 93.3% (95%CI, 88.6%-96.6%), positive likelihood ratio 13.7, and negative likelihood ratio 0.1. Sensitivity was 63.6% for frozen sections and 47.1% for touch imprint cytology. Both methods were 100% specific. Positive histology and positive OSNA were significantly associated with highest clinical stage, N1 status, and vascular invasion; and OSNA results correlated with HER2/neu status and benefited patients with negative histology. These findings show that OSNA assay can allow detection of SLN metastasis in breast cancer patients intra-operatively with a good sensitivity thus minimizing the need for second surgeries for axillary lymph node detection.

Published
2011
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22. Clear margins for invasive lobular carcinoma: A surgical challenge

Author

R.A. Sakr, Krishna B. Clough, Gabriel J. Kaufman, C. Nos, and B. Poulet

Subjects
Adult, Paris, medicine.medical_specialty, medicine.medical_treatment, Breast surgery, Breast Neoplasms, Mastectomy, Segmental, Risk Assessment, Risk Factors, Carcinoma, Humans, Medicine, skin and connective tissue diseases, Aged, Neoplasm Staging, Retrospective Studies, Analysis of Variance, Sentinel Lymph Node Biopsy, business.industry, Patient Selection, Carcinoma, Ductal, Breast, Cancer, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Surgery, Oncoplastic Surgery, Carcinoma, Lobular, Axilla, medicine.anatomical_structure, Oncology, Invasive lobular carcinoma, Lymph Node Excision, Female, business, Mastectomy
Abstract

Background The main goal of breast conservative surgery (BCS) is the complete removal of cancer with clear margins and no deformity of the breast. However, in invasive lobular carcinoma (ILC) this goal is hard to achieve because of the underestimation of tumor size. Our study was the first to show the role of surgical techniques in the achievement of clear margins for ILC. Methods We reviewed 73 patients with ILC who underwent BCS at Paris Breast Center between January 2005 and June 2008. Full thickness excision (FTE) was performed in a routine basis and oncoplastic surgery (OPS) upon tumor location, volume ratio and overall density of the breast. Margin status was evaluated as positive, close or clear. Results Positive/close margins were found in 39% of cases and were lower than what was described in the literature (49–63%). FTE was performed in 47 (64%) patients and OPS in 26 (36%) patients. No positive/close margins were observed in patients with lesions located in the lower/central quadrants. Multivariate analysis showed multifocality, larger tumor size and FTE to be independent risk factors for positive margins at final surgery. Conclusions Our rate of positive/close margins for ILC was lower than what was described in the literature. The determinant key difference was in our surgical procedures with FTE or OPS differing from the standard BCS described in the literature and we suggest that OPS is to be considered for ILC. It allows larger breast conservative surgery with good cosmetic results and lower rate of compromised margins.

Published
2011
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23. Actualité du traitement du cancer de l’endomètre : faut-il faire des lymphadénectomies et lesquelles ?

Author

Chérazade Bensaid, C. Nos, A S Bats, Cyrille Huchon, C. Scarabin, and Fabrice Lecuru

Subjects
Reproductive Medicine, Obstetrics and Gynecology, General Medicine
Abstract

Resume Le cancer de l’endometre est une tumeur de bon pronostic, souvent diagnostiquee a un stade precoce. Neanmoins, il existe, parmi les stades I, 5 a 20 % d’envahissements ganglionnaires. La connaissance du statut ganglionnaire apporte une information pronostique essentielle. Celle-ci est malheureusement mal evaluee par le bilan preoperatoire et la lymphadenectomie a visee pronostique apparait donc justifiee. En revanche, le benefice therapeutique des curages pelviens et lomboaortiques est controverse. Les derniers essais randomises ne retrouvent pas d’impact sur la survie pour les patientes a bas niveau de risque d’envahissement ganglionnaire. Ainsi, dans ce groupe de patientes, le curage ne devrait plus etre considere comme une pratique systematique. Neanmoins, le groupe a haut risque semble, lui, beneficier non seulement du curage pelvien, mais egalement lomboaortique, en raison de la possibilite d’envahissement lomboaortique isole.

Published
2010
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24. Ensemble-plus Study Design: An Investigation of Shortened Ocrelizumab Infusion Time on Infusion-related Reactions in Patients with Relapsing Multiple Sclerosis from the Phase Iiib Ensemble-plus Study

Author

C. Nos, H.-P. Hartung, B. Yamout, Bruno Brochet, Qing Wang, J. Killstein, L. Mehta, K. Fitovski, James Overell, Mark S. Freedman, and Regine Buffels

Subjects
medicine.medical_specialty, Infusion time, business.industry, Multiple sclerosis, Urology, General Medicine, medicine.disease, Neurology, medicine, Ocrelizumab, In patient, Neurology (clinical), business, medicine.drug
Published
2018
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25. Place de la cœlioscopie dans le traitement des cancers de l’endomètre à un stade précoce (stade I)

Author

P. Capmas, Cyrille Huchon, Fabrice Lecuru, C. Scarabin, Chérazade Bensaid, C. Nos, and A S Bats

Subjects
Gynecology, Coelioscopy, medicine.medical_specialty, Reproductive Medicine, media_common.quotation_subject, medicine, Obstetrics and Gynecology, General Medicine, Art, media_common
Abstract

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 38 - N° 7 - p. 537-544

Published
2009
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27. [Axillary management in breast cancer: The French practice versus recommendations in the post-2011 era]

Author

A, Clavier, C, Cornou, P, Capmas, A-S, Bats, C, Bensaid, C, Nos, F, Lécuru, and C, Ngô

Subjects
Surgeons, Sentinel Lymph Node Biopsy, Breast Neoplasms, Neoadjuvant Therapy, Chemotherapy, Adjuvant, Lymphatic Metastasis, Surveys and Questionnaires, Axilla, Practice Guidelines as Topic, Humans, Lymph Node Excision, Female, Radiotherapy, Adjuvant, France, Practice Patterns, Physicians'
Abstract

Today, according to St-Gallen and ASCO clinical guidelines, axillary lymph node dissection (ALND) should be avoided in patients who meet the ACOSOG Z011 criteria. In French guidelines, ALND is still recommended in case of macrometastasis in sentinel lymph node (SLN) and in case of micrometastasis without systemic treatment. We performed a survey of the French practices in the management of the axilla.A questionnaire was sent to 454 breast surgeons between June 2014 and January 2015. Questionnaire included items about: indications of SLN biopsy, frequency of ALND in case of metastatic SLN and modality of radiotherapy in case of metastatic SLN without ALND.A total of 169 surgeons (37%) answer the questionnaire. Twenty-one percent of surgeons avoid ALND in case of macrometastasis. Thirty-two percent do not perform extemporaneous examination of SLN. Only 8.4% of practionners performed a SLN biopsy after neoadjuvant chemotherapy. Fourteen percent performed a SLN biopsy in case of multicentric tumors, while it is not recommended. In case of positive SLN without ALND completion, radiotherapy does not change in 34% while irradiation fields are expanded in 44%.Significant unconformities are observed towards national recommendations. The divergence between French and international guidelines leads to heterogeneous surgical practices.

Published
2015

29. Out-of-hospital follow-up after low risk breast cancer within a care network: 14-year results

Author

Alain Fourquet, Nasrine Callet, Flora Breuil Crockett, Sophie Houzard, Coraline Dubot, C. Nos, Richard Villet, Isabelle Dagousset, Sylvie Fridmann, Anne Thoury, Christine Rousset-Jablonski, and Suzette Delaloge

Subjects
Out of hospital, Adult, Pediatrics, medicine.medical_specialty, Organizational innovation, Primary Health Care, business.industry, Disease Management, Breast Neoplasms, General Medicine, Relapse rate, Middle Aged, medicine.disease, Breast cancer, medicine, Ambulatory Care, Humans, Surgery, Female, Longitudinal Studies, Prospective Studies, Stage (cooking), Neoplasm Recurrence, Local, business, Aged
Abstract

The delegation of low-risk breast cancer patients' follow-up to non-hospital practitionners (NHP), including gynaecologists and general practitioners, has been assessed prospectively within a care network in the Paris region. Patients with early stage breast cancer were eligible. The follow-up protocol was built according to international guidelines. By 2012, 289 NHPs were following 2266 patients treated in 11 centres. Median follow-up time was 7.4 years. The mean intervals between two consecutive consultations were 9.5 [9.2–9.8] months for women supposed to be monitored every 6 months and 12.5 [12.2–12.8] for those requiring annual monitoring. The relapse rate was 3.2% [2.1–4.3] at 5 years and 7.8% [5.9–9.7] at 10 years. Seventy one percent of relapses were diagnosed on a scheduled assessment. Only 6% were lost-to-follow-up. Delegating follow-up after low risk breast cancer to NHPs in a care network is feasible, well accepted and provides an alternative to follow-up in specialized centres.

Published
2013

30. Analyse rétrospective d’une série de 770 prothèses PIP

Author

C. Nos, K. B. Clough, I. Sarfati, Eleanore Massey, M. Meunier, and C. Alaeddine

Abstract

Le signalement de ruptures anormalement precoces de protheses Poly Implant Prothese (PIP) a permis la decouverte de ce qui apparait etre une fraude industrielle, pouvant concerner des centaines de milliers de patientes dans le monde. Cette decouverte a abouti a l’interdiction de la commercialisation de ces implants, puis a la recommandation, en France et dans de nombreux autres pays, d’explantation systematique. a ce jour, peu d’etudes ont analyse le taux de rupture de ces implants ou le suivi cancerologique des femmes ayant eu l’implantation de protheses PIP.

Published
2013
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31. Impact of gynecologic screening in Lynch syndrome

Author

Charlotte Ngo, Chérazade Bensaid, C. Nos, G. Vannieuwenhuyse, A S Bats, Fabrice Lecuru, C Cornou, and P Capmas

Subjects
medicine.medical_specialty, Oncology, business.industry, General surgery, Obstetrics and Gynecology, Medicine, business, medicine.disease, Lynch syndrome
Published
2016
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32. [Autologous fat grafting to the postmastectomy irradiated chest wall prior to breast implant reconstruction: a series of 68 patients]

Author

I, Sarfati, T, Ihrai, A, Duvernay, C, Nos, and K, Clough

Subjects
Adult, Esthetics, Breast Implants, Breast Neoplasms, Middle Aged, Prosthesis Failure, Postoperative Complications, Adipose Tissue, Humans, Female, Radiation Injuries, Thoracic Wall, Mastectomy, Aged, Follow-Up Studies
Abstract

After radiotherapy, breast reconstruction with an implant carries a high risk of failure and complication. Clinical and experimental studies have demonstrated that grafting adipose tissue (lipofilling) in an irradiated area enhances skin trophicity. Thus, we have started performing preliminary fat grafting to the irradiated chest wall prior to implant reconstruction in order to limit complications and failure risk.Patients were included in this study from 2007 to 2011. All patients had had mastectomy and irradiation for breast cancer. They all had one or more sessions of lipofilling prior to breast implant reconstruction. These patients were prospectively followed up in order to collect the following data: postoperative complications; cosmetic result; local breast cancer recurrences.Sixty-eight patients were included. The mean number of fat grafting sessions was 2.3 (range 1-6). An average volume of 115mL (70-275) was injected each time. The mean volume of breast implants was 300mL (185-400). The mean follow-up was 23months (450). No breast cancer local recurrence was diagnosed during follow-up. Implant explantation was performed in one case (1.47%) The mean cosmetic result was 4.5/5.Fat grafting to the irradiated chest wall prior to implant placement might be an alternative to flap reconstruction for patients who are not suitable or who refuse this option.

Published
2012

33. Change in the clinical activity of multiple sclerosis after treatment switch for suboptimal response

Author

J, Río, M, Tintoré, J, Sastre-Garriga, C, Nos, J, Castilló, C, Tur, M, Comabella, and X, Montalban

Subjects
Adult, Male, Young Adult, Multiple Sclerosis, Secondary Prevention, Humans, Immunologic Factors, Female, Glatiramer Acetate, Interferon-beta, Treatment Failure, Peptides
Abstract

Therapy for multiple sclerosis (MS) has a partial efficacy, and a significant proportion of treated patients will develop a suboptimal response with first-line disease-modifying drugs (DMD). Therapy switch in patients with MS can be a strategy after a treatment failure. We studied the change in clinical activity after switching of first-line DMD because of a treatment failure. Relapsing-remitting multiple sclerosis (RRMS) patients treated with interferon-beta (IFNB) or glatiramer acetate (GA) were divided into (i) patients without change in DMD, (ii) patients with a change in DMD because of a poor response, and (iii) those with a change in DMD without relation with response. Annualized relapse rate (ARR) and relapse-free proportions were analyzed. We identified 923 patients with RRMS. Of the 180 who experienced a change because of suboptimal response, 90 switched to another first-line DMT, 38 to mitoxantrone, and 52 to natalizumab. Median ARR in the pre-DMD period on first DMD and second DMD was the following: 1, 1, and 0 for switchers from IFNB to another IFNB (P = 0.0001); 0.67, 1, and 0 for switchers from GA to IFNB (P = 0.01); 1, 1, and 0 for switchers from an IFNB to GA (P = 0.02); 1.1, 1.5, 0.2 for switchers from IFNB or GA to mitoxantrone (P = 0.0001); 0.9, 1, 0 for switchers from IFNB or GA to natalizumab (P = 0.0001). In patients with RRMS who have a poor response, switch to another DMD may reduce the clinical activity of the disease.

Published
2012

35. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. 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Valalentino, D. Guidetti, B. Buchwald, C. H. Lücking, D. Gauvreau, F. Pfaff, A. Ben Younes-Chennoufi, R. Kiefer, R. Massot, K. A. Hossmann, L. Werdelin, P. J. Baxter, U. Ziflo, S. Allaria, C. D. Marsden, M. Cabaret, S. P. Mueller, E. Calabrese, R. Colao, S. I. Bekkelund, M. Yilmaz, O. Oktem-Tanor, R. Gine, M. E. Scheulen, J. Beuuer, A. Melo, Z. Gulay, M. D. Have, C. Frith, D. Liberati, J. Gozlan, P. Rondot, Ch. Brunholzl, M. Pocchiari, J. Pena, L. Moiola, C. Salvadori, A. Cabello, T. Catarci, S. Webb, C. Dettmers, N. A. Gregson, Alexandra Durr, F. Iglesias, U. Knorr, L. Ferrini-Strambi, F. Kruggel, P. Allard, A. Coquerel, P. Genet, F. Vinuels, C. Oberwittler, A. Torbicki, P. Leffers, B. Renault, B. Fauser, C. Ciano, G. Uziel, J. M. Gibson, F. Anaya, C. Derouesné, C. N. Anagnostou, M. Kaido, W. Eickhoff, G. Talerico, M. L. Berthier, A. Capdevila, M. Alons, D. Rezek, E. Wondrusch, U. Kauerz, D. Mateo, M. A. Chornet, Holon, N. Pinsard, I. Doganer, E. Paoino, H. Strenge, C. Diaz, J. R. Brasic, W. Heide, I. Santilli, W. M. Korn, D. Selcuki, M. J. Barrett, D. Krieger, T. Leon, T. Houallah, M. Tournilhac, C. Nos, D. Chavot, F. Barbieri, F. J. Jimenez-Jimenez, J. Muruzabal, K. Poeck, A. Sennlaub, L. M. Iriarte, L. G. Lazzarino, C. Sanz, P. A. Fischer, S. D. Shorvon, R. Hoermann, F. Delecluse, M. Krams, O. Corabianu, F. H. Hochberg, Christopher J. Mathias, B. Debachy, C. M. Poser, L. Delodovici, A. Jimenez-Escrig, F. Baruzzi, F. Godenberg, D. Cucinotta, P. J. Garcia Ruiz, K. Maier-Hauff, P. R. Bar, R. Mezt, R. Jochens, S. Karakaneva, C. Roberti, E. Caballero, Joseph E. Parisi, M. Zamboni, T. Lacasa, B. Baklan, J. C. Gautier, J. A. Martinez-Matos, W. Pollmann, G. Thomas, L. Verze, E. Chleide, R. Alvarez Sala, I. Noel, E. Albuisson, O. Kastrup, S. I. Rapoport, H. J. Braune, H. Lörler, M. Le Merrer, A. Biraben, S. Soler, S. J. Taagholt, U. Meyding-Lamadé, K. Bleasdale-Barr, Isabella Moroni, Y. Campos, J. Matias-Guiu, G. Edan, M. G. Bousser, John B. Clark, J. Garcia de Yebenes, N. K. Olsen, P. Hitzenberger, S. Einius, Aj Thompson, Ch. J. Vecht, T. Crepin-Leblond, Klaus L. Leenders, A. Di Muzio, L. Georgieva, René Spiegel, K. Sabey, D. Ménégalli, J. Meulstee, U. Liszka, P. Giral, C. Sunol, J. M. Espadaler, A. D. Crockar, K. Varli, G. Giraud, P. J. Hülser, A. Benazzouz, A. Reggio, M. Salvatore, K. Genc, M. Kushnir, S. Barbieri, J. Ph. Azulay, M. Gianelli, N. Bathien, A. AlMemar, F. Hentati, I. Ragueneau, F. Chiarotti, R. C. F. Smits, A. K. Asbury, F. Lacruz, B. Muller, Alan J. Thompson, Gordon Smith, K. Schmidt, C. Daems Monpeun, Juergen Weber, A. Arboix, G. R. Fink, A. M. Cobo, M. Ait Kaci Ahmed, E. Gencheva, Israel-Biet, G. Schlaug, P. De Jonghe, Philip Scheltens, K. Toyka, P. Gonzalez-Porque, A. Cila, J. M. Fernandez, P. Augustin, J. Siclia, S. Medaglini, D. E. Ziogas, A. Feve, L. Kater, G. J. E. Rinkel, D. Leppert, Rüdiger J. Seitz, S. Ried, C. Turc-Carel, G. Smeyers, F. Godinho, M. Czygan, M. Rijntjes, E. Aversa, M. Frigo, Leif Østergaard, J. L. Munoz Blanco, A. Cruz-Matinez, J. De Reuck, C. Theillet, T. Barroso, V. Oikonen, Florence Lebert, M. Kilinc, C. Cordon-Cardon, G. Stoll, E. Thiery, F. Pulcinelli, J. Solski, M. Schmiegelow, L. J. Polman, P. Fernandez-Calle, C. Wikkelso, M. Ben Hamida, M. Laska, E. Kott, W. Sulkowski, C. Lucas, N. M. Bornstein, D. Schmitz, M. W. Lammers, A. de Louw, R. J. S. Wise, P. A. van Darn, C. Antozzi, P. Villanueva, P. H. E. Hilkens, C. Constantin, W. Ricart, A. Wolf, M. Gamba, P. Maguire, Alessandro Padovani, B. M. Patten, Marie Sarazin, H. Ackermann, L. Durelli, S. Timsit, Sebastian Jander, B. W. Scheithauer, G. Demir, J. P. Neau, P. Barbanti, A. Brand, N. AraÇ, V. Fischer-Gagnepain, R. Marchioli, G. Serratrice, C. Maugard-Louboutin, G. T. Spencer, D. Lücke, G. Mainardi, K. Harmant Van Rijckevorsel, G. B. Creel, R. Manzanares, Francesco Fortunato, A. May, J. Workman, K. Johkura, E. Fernandez, Carlo Colosimo, L. Calliauw, L. Bet, Félix F. Cruz-Sánchez, M. Dhib, H. Meinardi, F. Carrara, J. Kuehnen, C. Peiro, H. Lassmann, K. Skovgaard Olsen, A. McDonald, L. Sciulli, A. Cobo, A. Monticelli, B. Conrad, J. Bagunya, J. Benitez, V. Desnizza, B. Dupont, O. Delrieu, D. Moraes, J. J. Heimans, F. Garcia Rio, M. Matsumto, A. Fernandez, R. Nermni, R. Chalmers, M. J. Marchau, F. Aguado, P. Velupillai, P. J. Martin, P. Tassan, V. Demarin, A. Engelien, T. Gerriets, Comar, J. L. Carrasco, J. P. Pruvo, A. Lopez de Munain, D. Pavitt, J. Alarcon, Chris H. Polman, B. Guldin, N. Yeni, Hartmut Brückmann, N. Wilczak, H. Szwed, R. Causaran, G. Kyriazis, M. E. Westarp, M. Gasparini, N. Pecora, J. M. Roda, E. Lang, V. Scaioli, David R. Fish, D. Caputo, O. Gratzl, R. Mercelis, A. Perretti, G. Steimetz, I. Link, C. Rigoletto, A. Catafau, G. Lucotte, M. Buti, G. Fagiolari, A. Piqueras, C. Godinot, J. C. Meurice, Erodriguez J. Dominigo, F. Lionnet, H. Grzelec, David J. Brooks, P. M. G. Munro, F. X. Weilbach, M. Maiwald, W. Split, B. Widjaja-Cramer, V. Ozturk, J. Colas, E. Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. Santoro, J. Roda, A. Bordoni, D. J. Taylor, S. Ertas, H. H. Emmen, J. Vichez, V. BesanÇon, R. E. Passingham, M. L. Malosio, A. Vérier, M. Bamberg, A. W. Hansen, E. Mostacero, G. Gaudriault, Marie Vidailhet, B. Birebent, K. Strijckmans, F. Giannini, T. Kammer, I. Araujo, J. Nowicki, E. Nikolov, A. Hutzelmann, R. Gherardi, J. Verroust, L. Austoni, A. Scheller, A. Vazquez, S. Matheron, H. Holthausen, J. M. Gerard, M. Bataillard, S. Dethy, V. H. Patterson, V. Ivanez, N. P. Hirsch, F. Ozer, M. Sutter, C. Jacomet, M. Mora, Bruno Colombo, A. Sarropoulos, T. H. Papapetropoulos, M. Schwarz, D. S. Dinner, N. Acarin, B. Iandolo, J. O. Riis, P. R. J. Barnes, F. Taroni, J. Kazenwadel, L. Torre, A. Lugaresi, I. L. Henriques, S. Pauli, S. Alfonso, Pedro Quesada, A. S. T. Planting, J. M. Castilla, Thomas Gasser, M. Van der Linden, A. Alfaro, E. Nobile-Orazio, G. Popova, W. Vaalburg, F. G. A. van der Mech, L. Williams, F. Medina, J. P. Vernant, J. Yaouanq, B. Storch-Hagenlocher, A. Potemkowski, R. Riva, M. H. Mahagne, M. Ozturk, Ve. Drory, N. Konic, C. Jungreis, A. Pou Serradell, J. L. Gauvrit, G. J. Chelune, S. Hermandez, T. Dingus, L. Hewer, Ch. Koch, M. N. Metz-Lutz, G. Parlato, M. Sinaki, Charles Pierrot-Deseilligny, H. C. Diener, J. Broeckx, J. Weill-Fulazza, M. L. Villar, M. Rizzo, O. Ganslandt, C. Duran, N. A. Fletcher, G. Di Giovacchino, Susan T. Iannaccone, C. Kolig, N. Fabre, H. A. Crockard, Rita Bella, M. Tazir, E. Papagiannuli, K. Overgaard, Emma Ciafaloni, I. Lorenzetti, F. Viader, P. A. H. Millac, I. Montiel, L. H. Visser, M. Palomar, P. L. Murgia, H. Pedersen, Rafael Blesa, S. Seddigh, W. O. Renier, I. Lemahieu, H. M. L. Jansen, L. Rosin, J. Galofre, K. Mattos, M. Pondal, G. M. Hadjigeorgiou, D. Francis, L. Cantin, D. Stegeman, M. Rango, A. B. M. F. Karim, S. Schraff, B. Castellotti, I. Iriarte, E. Laborde, T. J. Tjan, R. Mutani, D. Toni, B. Bergaasco, J. G. Young, C. Klotzsch, A. Zincone, X. Ducrocq, M. Uchuya, O. J. Kolar, A. Quattrone, T. Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. Butterfield, P. P. Costa, F. deRino, F. Bamonti, J. M. Cesar, C. H. Lahoz, I. Mosely, M. Starck, M. H. Lemaitre, K. M. Stephan, S. Tex, R. Bokonjic, I. Mollee, L. Pastena, M. Gutierrez, F. Boiler, M. C. Martinez-Para, M. Velicogna, O. Obuz, A. Grinspan, M. Guarino, L. M. Cartier, E. Ruiz, D. Gambi, S. Messina, M. Villa, Michael G. Hanna, J. Valk, Leone Pascual, M. Clanet, Z. Argov, B. Ryniewicz, E. Magni, B. Berlanga, K. S. Wong, C. Gellera, C. Prevost, F. Gonzalez-Huix, R. Petraroli, J. E. G. Benedikz, I. Kojder, C. Bommelaer, L. Perusse, M. R. Bangioanni, Guy M. McKhann, A. Molina, C. Fresquet, E. Sindern, Florence Pasquier, M. J. Rosas, M. Altieri, O. Simoncini, M. Koutroumanidis, C. A. F. Tulleken, M. Dary-Auriol, S. Oueslati, H. Kruyer, I. Nishisho, C. R. Horning, A. Vital, G. V. Czettritz, J. Ph. Neau, B. Mihout, A. Ameri, M. Francis, S. Quasthoff, D. Taussig, S. Blunt, P. Valentin, C. Y. Gao, O. Heinzlef, H. d'Allens, C. Coudero, M. Erfas, G. Borghero, P. J. Modrego Pardo, M. C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994
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37. [Sentinel lymph node biopsy and axillary reverse mapping: a tailoring axillary staging in breast cancer]

Author

P, Cusumano, V, Bleret, C, Nos, R, Hustinx, H, Lilet, P, Gomez, and E, Lifrange

Subjects
Sentinel Lymph Node Biopsy, Axilla, Humans, Lymph Node Excision, Breast Neoplasms, Female, Lymph Nodes
Abstract

The status of the axillary lymph nodes is one of the most important prognostic factors in women with early stage breast cancer. Histologic examination of removed lymph nodes is the most accurate method for assessing spread of disease to these nodes. Axillary lymph node dissection (ALND) remains the standard approach for women who have clinically palpable axillary nodes. The benefits of ALND include its impact on disease control (axillary recurrence and survival), its prognostic value, and its role in treatment selection. However, the anatomic disruption caused by ALND may result in lymphedema, nerve injury, and shoulder dysfunction, which compromise functionality and quality of life. For patients who have clinically negative axillary lymph nodes, sentinel lymph node (SLN) biopsy offers a less morbid method to determine if there are positive nodes, in which case axillary node dissection would be necessary. Patients who are SLN-positive should undergo complete ALND. Axillary reverse mapping (ARM) is a recent improvement of ALND which, like the biopsy of the GS, would reduce morbidity.

Published
2011

38. Hirano body-rich subtypes of Creutzfeldt-Jakob disease

Author

E, Martinez-Saez, E, Gelpi, M J, Rey, I, Ferrer, T, Ribalta, T, Botta-Orfila, C, Nos, J, Yagüe, and R, Sanchez-Valle

Subjects
Adult, Male, 14-3-3 Proteins, PrPSc Proteins, Blotting, Western, Age Factors, Brain, Humans, Female, Middle Aged, Hippocampus, Creutzfeldt-Jakob Syndrome, Aged
Abstract

In definite Creutzfeldt-Jakob disease (CJD), morphological and immunohistochemical patterns are useful to identify molecular subtypes. Severe cerebellar pathology and hippocampal involvement helps to identify VV subtypes. The rare VV1 variant (1%), more frequent in young individuals, is additionally characterized by the presence of ballooned neurones in affected areas. In 1985, Cartier et al. described a family cluster of three individuals with an ataxic CJD form, showing, in addition to severe cerebellar and hippocampal involvement, the presence of frequent Hirano bodies (HB) in CA1 pyramidal neurones. HB are frequently found in aged individuals with Alzheimer pathology although they are not a specific finding.In this study, we evaluated the presence of HB in hippocampi of 54 genetically and molecularly characterized CJD cases, aiming to elucidate whether additional morphological features could be helpful to point to molecular subtypes.We identified nine cases (four VV1, one out of three MV2K, three out of six MV2K+2C and one MV carrying a 96-base pair insertion) with abundant, partly bizarre and clustered HB in CA1 sector, not observed in other subtypes. The presence of HB was independent of hippocampal involvement by the disease itself.Clusters of abundant HB might be found in rare CJD subtypes such as VV1, MV2K/MV2K+2C and some genetic cases. In addition to histopathological and PrP immunohistochemical deposition patterns, their presence might be a useful additional morphologic feature that could point to the molecular subtype, especially when genetic and/or Western blot analyses are not available.

Published
2011

39. [Current indications of lymphadenectomy in endometrial cancer]

Author

A-S, Bats, C, Bensaïd, C, Huchon, C, Scarabin, C, Nos, and F, Lécuru

Subjects
Humans, Lymph Node Excision, Female, Prognosis, Carcinoma, Endometrioid, Endometrial Neoplasms, Randomized Controlled Trials as Topic
Abstract

Endometrial cancer is a tumor associated with a good prognosis as it is often diagnosed at an early stage. Up to 20 % of patients with stage I disease have a nodal involvement. Knowledge of nodal status provides important prognostic information. As preoperative assessment yields a poor value, prognostic lymphadenectomy appears to be indicated. However, therapeutic benefit of pelvic and para-aortic lymphadenectomy remains controversial. Recent randomized trials did not find any impact on survival for patients with low risk of nodal involvement. Thus, lymphadenectomy should no more be systematically performed in this low risk group. Nevertheless, pelvic and para-aortic lymphadenectomy seems to have a benefit in the high risk group, as isolated involved para-aortic nodes have been described.

Published
2010

40. [Surgical treatment of early endometrial cancer: what are the benefits of laparoscopy?]

Author

P, Capmas, A-S, Bats, C, Bensaid, C, Huchon, C, Scarabin, C, Nos, and F, Lécuru

Subjects
Quality of Life, Humans, Female, Laparoscopy, Neoplasm Recurrence, Local, Endometrial Neoplasms
Abstract

The development of gynaecologic laparoscopic surgery has also spread into some areas of the pelvic cancer surgery. Nevertheless, in France, less than 5% of interventions for endometrial cancer are currently performed by laparoscopy. As compared with laparotomy, laparoscopy, which is equally effective, provides per- and postoperative benefits, with comparable recurrence and survival rates. Operators' training seems to be the most significant limitation to the development of laparoscopy in the surgical treatment of early endometrial cancer.

Published
2009

41. [Response of V. Lavoué to the article of G Akerman et al. Simplified technique of radioguided occult lesion localization in breast cancer: techniques of the future? Gynecol Obstet Fertil 2009;37:45-9]

Author

V, Lavoué, C, Nos, and F, Lécuru

Subjects
Adult, Aged, 80 and over, Sentinel Lymph Node Biopsy, Carcinoma, Ductal, Breast, Breast Neoplasms, Middle Aged, Radiography, Carcinoma, Lobular, Carcinoma, Intraductal, Noninfiltrating, Humans, Female, Lymph Nodes, Ultrasonography, Mammary, Radiopharmaceuticals, Radionuclide Imaging, Aged
Published
2009

42. Sentinel lymph nodes in endometrial cancer: is hysteroscopic injection valid?

Author

D, Clement, A S, Bats, N, Ghazzar-Pierquet, M A, Le Frere Belda, F, Larousserie, C, Nos, and F, Lecuru

Subjects
Sentinel Lymph Node Biopsy, Uterine Neoplasms, Humans, Female, Hysteroscopy, Lymph Nodes, Coloring Agents, Radionuclide Imaging, Endometrial Neoplasms, Injections
Abstract

We aimed to describe hysteroscopic peritumoral tracer injection for detecting sentinel lymph nodes (SLNs) in patients with endometrial cancer and to evaluate tolerance of the procedure, detection rate and location of SLNs. Five patients with early endometrial cancer underwent hysteroscopic radiotracer injection followed by lymphoscintigraphy, then by surgery with hysteroscopic peritumoral blue dye injection, and radioactivity measurement using an endoscopic handheld gamma probe. SLNs and other nodes were sent separately to the pathology laboratory. SLNs were evaluated by hematoxylin-eosin-saffron staining and, when negative, by immunohistochemistry. Tolerance of the injection by the patients was poor (mean visual analog scale score, 8/10). SLNs were detected in only two patients (external iliac and common iliac+paraaortic, respectively). Detection rates were 1/5 by radiotracer, 1/5 by dye, and 2/5 by the combined method. One SLN was involved in a patient whose other nodes were negative. In three patients no SLNs were found by radiotracer or blue dye. Of the 83 non sentinel nodes removed from these patients, none was involved. Hysteroscopic peritumoral injection may be more difficult than cervical injection and, in our experience, carries a lower SLN detection rate.

Published
2008

43. [Partial reconstruction after conservative treatment for breast cancer: classification of sequelae and treatment options]

Author

K B, Clough, C, Nos, A, Fitoussi, B, Couturaud, C, Inguenault, and I, Sarfati

Subjects
Adult, Postoperative Complications, Mammaplasty, Humans, Breast Neoplasms, Female, Middle Aged, Mastectomy, Aged
Abstract

Most patients presenting with breast cancer are treated by breast conserving treatment (BCT). Some of these patients present with poor cosmetic results and ask for partial breast reconstruction. These reconstructions following BCT are presenting more frequently to plastic surgeons as a difficult management problem. We have defined and published a classification of the different cosmetic sequelae (CS) after BCT into three types. This classification helps to analyse these complex deformities aggravated by radiotherapy. Furthermore, our classification helps to choose between the different surgical techniques and propose the optimal option for their surgical correction. Our initial publications reported 35 and 85 patients: we have currently operated more than 150 cases of CS after BCT. Type-1 CS are defined by an asymmetry between the two breasts, with no distortion or deformity of the radiated breast. Type-2 CS are those with an obvious breast deformity, that can be corrected with a partial reconstruction of the breast. Type-3 CS are those with such a deformity that only a mastectomy with total reconstruction of the breast can be performed. Most of the patients present with type-2 CS, but are reluctant to undergo what they feel is a major reconstructive procedure: in a initial prospective series of 85 patients operated for CS after BCT, 48 (56.5%) had type-1 CS, 33 patients (38.8%) type-2 CS and four patients (4.7%) type-3 CS. Type-1 patients should be managed essentially by contralateral symmetrizing procedures. One should limit any surgery on the radiated breast, as a mammoplasty or an augmentation is at high risk of complications. Type-2 is the most difficult to manage and requires all the surgical armamentarium of breast reconstructive surgery. The insetting of a myocutaneous flap is often necessary and autologous fat grafting is a promising tool in selected cases. Type-3 CS requires mastectomy and immediate reconstruction with a myocutaneous flap. The major development though in the past 10 years has been the development of oncoplastic techniques at the time of the original tumour removal, in order to avoid most of type 2 and type 3 deformities. This paper reaffirms the validity of the Cosmetic Sequelae classification as a simple, practical guide for breast reconstructive surgeons. It discusses the various choices of reconstructive procedures available, the importance of "preventing" these CS and defining the role of the plastic surgeon in the management of these patients.

Published
2007

44. Curages axillaires séparés sein-bras dans les cancers du sein avancés

Author

Fabrice Lecuru, B. Loridon, Krishna B. Clough, C. Nos, Bruno Poulet, E. Zerbib, B. Lesieur, Marie-Anne Collignon, and M. A. Le Frère-Belda

Abstract

Objectifs: Le traitement locoregional de l’aisselle dans les cancers du sein avances comporte un curage axillaire suivi, s’il existe un ou plusieurs ganglions envahis, d’une irradiation des aires ganglionnaires (1). Ce schema therapeutique expose particulierement au risque de lymphoedeme du membre superieur. Pour diminuer ce risque, nous proposons de pratiquer un curage axillaire separant les ganglions en rapport avec le sein, susceptibles d’etre metastatiques, des ganglions en rapport avec le bras qu’il faudrait essayer d’individualiser. Le principe de detection est d’injecter un traceur lymphophile dans le membre superieur, qui permet l’identification des trajets lymphatiques en rapport avec le bras. Il s’agit d’une nouvelle approche chirurgicale qui a ete validee chez l’animal (2) et qui a fait l’objet d’une publication recente a propos d’une etude pilote utilisant le bleu patent (3). Nous proposons de poursuivre ces travaux en utilisant une methode de detection isotopique.

Published
2007
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45. Prise de décision face à des atypies glandulaires

Author

M. Junger, F. Larousserie, A S Bats, C. Nos, Fabrice Lecuru, M A Le Frère Belda, and Chérazade Bensaid

Abstract

Les anomalies glandulaires (AGC) sont rarement retrouvees sur les frottis de depistage ( 30 %) une pathologie reelle, du col, de l’endometre ou des annexes. Le risque de neoplasie est important lorsque le frottis est de type « favor neoplasia », ou chez les femmes d’un âge superieur a 35 ans ou presentant des menometrorragies.

Published
2007
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46. [Breast-conserving therapy of breast cancer]

Author

V, Doridot, C, Nos, J S, Aucouturier, B, Sigal-Zafrani, A, Fourquet, and K B, Clough

Subjects
Adult, Clinical Trials as Topic, Sentinel Lymph Node Biopsy, Biopsy, Age Factors, Breast Neoplasms, Radiotherapy Dosage, Middle Aged, Mastectomy, Segmental, Combined Modality Therapy, Neoadjuvant Therapy, Chemotherapy, Adjuvant, Risk Factors, Preoperative Care, Humans, Lymph Node Excision, Minimally Invasive Surgical Procedures, Female, Breast, Ultrasonography, Mammary, Neoplasm Recurrence, Local, Mastectomy, Aged, Mammography, Retrospective Studies
Abstract

Breast-conserving treatment for breast cancer combines lumpectomy, axillary nodes treatment and radiotherapy of the breast. Conservative surgery and radiotherapy is now the standard treatment for unifocal, non inflammatory tumors, less than 3 cm in diameter. The widespread use of mammographic screening leads to a significant increase in the proportion of non palpable breast carcinomas, and has contributed to increase the proportion of breast conserving treatments. Neoadjuvant treatments (chemotherapy, radiotherapy and hormonotherapy) can also extend the indications of breast conservation to breast carcinomas larger than 3 cm. Furthermore, in the last ten years, new surgical procedures (sentinel node biopsy, oncoplastic surgery, minimal invasive surgery) have been developed, increasing the surgical possibilities. After a learning phase to establish new standards for these procedures, all these techniques are now part of our standard surgical apparel, thus extending the possibilities of breast conserving surgery.

Published
2003

48. [Relevance of combined radiation and surgical treatment of early invasive carcinoma of the cervix]

Author

J Y, Charvolin, C, Nos, A de L, Rochefordière, V J, Margerie, J C, Durand, and K B, Clough

Subjects
Adult, Postoperative Complications, Brachytherapy, Humans, Lymph Node Excision, Uterine Cervical Neoplasms, Female, Middle Aged, Hysterectomy, Combined Modality Therapy, Survival Analysis, Aged, Neoplasm Staging
Abstract

The aim of this study was to assess the result and the postherapeutic complications rates of preoperative radiation therapy and radical surgery in association, for stage IB to IIB cervical carcinoma. For 1983 to 1990, 314 patients were treated at the Institut Curie for stage IB to IIB cervical carcinoma. For small lesions, less than 4 cm, preoperative uterovaginal brachytherapy was performed (60 to 65 Gy), followed, 6 weeks later, by a modified radical hysterectomy (Piver type 2) with pelvic lymphadenectomy. Larger tumors were treated with pelvic radiotherapy (36 Gy), then by brachytherapy (30 Gy), followed, 6 weeks later, by the same surgical procedure. 82% of the tumors were 4 cm or smaller. 64% of tumors were completely sterilised by the preoperative radiation. 5 and 10-year actuarial survival rates were respectively 81% and 70 %. 5-year actuarial survival rate was 87.5% for stage I and 63% for stage II patients. 5-year local disease free survival rate was 88% for stage I and 73% for stage II patients. All complications were prospectively recorded. The early post operative complication rate was 6.3%, with no urinary complications. The late complication rate was 3.3%, mainly grade 2 sequelae. No ureteral fistulas were observed. By combined preoperative radiotherapy and surgery, adapting the dosimetry and the radicality of the procedure, we obtained cure rates and recurrence rates identical to those obtained with exclusive surgery or radiotherapy alone. However, the complication rate of the association of both adapted treatments, has considerably reduced the early and late complication rate.

Published
2002

49. The Developing Brain and Emotion Regulation - Implications for Psychopathology

Author

C. Nosarti

Subjects
preterm birth, brain development, emotion regulation, Psychopathology, Psychiatry, RC435-571
Abstract

In this talk I will describe a series of studies conducted at the Centre for the Developing Brain, King’s College London, that seek to increase our understanding of why infants who are born very early (before 32 weeks’ gestation) are more likely to develop socio-emotional problems when they grow up compared to infants who are born at term. As part of the Evaluation of Preterm Imaging study we carried out multimodal MRI at term in over 200 newborns and studied whether we could identify specific patterns of brain development in those infants who might develop problems with emotion regulation and general mental health as they grow-up. At the behavioural level, we found that very preterm children compared to term-born controls had more mental health problems, including anxiety and autism-spectrum behaviours. Preterm children had lower IQ, were less able to regulate their emotions and inhibit unwanted behaviours. Children’s tendency to attribute negative emotions to daily events, which could lead to increased anxiety, was associated with two main neonatal brain features. These were: 1) weaker structural connectivity in a long-range white matter projection tract called the uncinate fasciculus which connects the frontal lobe with the anterior temporal lobe and 2) altered fronto-limbic functional connectivity, both of which play a critical role in several aspects of social and emotional development. These findings show that early brain changes can be used to predict children’s social and emotional outcomes, hence could be used to inform preventative interventions aimed at averting and targeting emerging emotional disorders.

Published
2022
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