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Resume La paroi thoracique antero-laterale est une paroi articulee semi-rigide, osseuse, cartilagineuse et musculaire. La mecanique respiratoire depend de sa constitution intrinseque. Le vieillissement des tissus, voire une pathologie de ses constituants, peut alterer son bon fonctionnement a moindre cout energetique. Elle est egalement le lieu d’insertion d’elements musculaires pour les regions cervicale, scapulaire et abdominale, dont la fonction principale est associee a ces regions anatomiques. Cependant, leur fonction respiratoire accessoire peut s’averer importante pour compenser une insuffisance des constituants intrinseques de la paroi thoracique.

Background Stage IV non-small cell lung cancer (NSCLC) is considered incurable; however, some patients with only few metastases may benefit from treatment with a curative intent. We aimed to identify the prognostic factors for stage IV NSCLC with synchronous solitary M1. Methods A database constructed from our weekly multidisciplinary thoracic oncology meetings was retrospectively screened from 1993 to 2012. Consecutive patients with NSCLC stages I to IV were included. Results Of the 6,760 patients found, 4,832 patients were studied. Among the 1,592 patients (33%) with stage IV NSCLC, 109 (7%) had a synchronous solitary M1. Metastasis involved the brain in 64% of patients. Median overall survival was significantly longer in synchronous solitary M1 than in other stage IV (18.9 months, interquartile range [IQR]: 9.9 to 34.6 months versus 6.1 months, IQR: 2.3 to 13.7 months], respectively, p Conclusions Synchronous solitary M1 treated with chemotherapy and operation at both sites resulted in better survival. Survival of NSCLC with synchronous solitary M1 was more similar to stage III than other stage IV NSCLCs. The eighth TNM classification takes this into account by distinguishing between stages M1b and M1c.

The prognosis of glioblastoma remains poor despite significant improvement in cytoreductive surgery, external irradiation and new approach of systemic treatment as antiangiogenic therapy. One of the issues is the low concentration in the infiltrated parenchyma of therapeutic agent administered intravenously mainly due to the blood–brain barrier. An intracerebral injection is advocated to overpass this barrier, this kind of administration need a low flow and continuous injection. The development of sophisticated implanted devices for convection-enhanced delivery is a mandatory step to have a controlled released of a therapeutic agent in glioblastoma treatment. Before testing such a device in a clinical trial a serious preclinical studies are required, in order to test it in realistic conditions we have develop the first induced high grade glioma model in a non-rodent animal: the pig. 21 pigs have been implanted in the parietal lobe with human glioblastoma cell lineage under a chemical immunosuppression by ciclosporine. A MRI follow up was then realized. 15 pigs have been implanted with U87MG, 14 have presented a macroscopic significant tumor, with radiological and anatomapathological characteristics of high grade glioma. 6 pigs were implanted with G6, stem-like cells tumors of glioblastoma, 1 pig develops a macroscopic tumor. This is the first reproducible glioma model in a large animal described, it open the way to preclinical studies to test implanted devices in anatomic realistic conditions, without the ethical issues of a primate use.

Viewing tumors as ecosystems offers the opportunity to consider how ecological concepts can be translated to novel therapeutic perspectives. The ecological trap concept emerged approximately half a century ago when it was observed that animals can prefer an environment of low quality for survival over other available environments of higher quality. The presence of such a trap can drive a local population to extinction. The cancer cell trap concept is the translation of the ecological trap into glioma therapy. It exploits and diverts the invasive potential of glioma cells by guiding their migration towards specific locations where a local therapy can be delivered efficiently. This illustrates how an ecological concept can change therapeutic obstacles into therapeutic tools.

International audience; Surgery is the first line therapy for glioma. However, glioma recurs in 90 % of the patients in the resection margin. The impact of surgical brain injury (SBI) on glioma recurrence is largely overlooked. Herein, we review some of the mechanisms involved in tissue repair that may impact glioma recurrence at the resection margin. Many processes or molecules involved in tissue repair after brain injury are also critical for glioma growth. They include a wide array of secreted growth factors, cytokines and transcription factors including NFКB and STAT3 which in turn activate proliferative and anti-apoptotic genes and processes such as angiogenesis and inflammation. Because some residual glioma cells always remain in the tumor resection margin, there are now compelling arguments to suggest that some aspects of the brain tissue response to SBI can also participate to glioma recurrence at the resection margin. Brain tissue response to SBI recruits angiogenesis and inflammation that precede and then follow tumor recurrence at the resection margin. The healingresponse to SBI is double edged, as inflammation is involved in regeneration and healing, and has both pro- and anti-tumorigenic functions. A promising therapeutic approach is to normalize and re-educate the molecular and cellular responses at the resection margin to promote anti- tumorigenic processes involved in healing while inhibiting pro-tumorigenic activities. Manipulation of the inflamma- tory response to SBI to prevent local recurrence could also enhance the efficacy of other therapies such as immunotherapy. However, our current knowledge is far from sufficient to achieve this goal. Acknowledging, understanding and manipulating the double-edged role played by SBI in glioma recurrence is surely challenging, but it cannot be longer delayed.

Though the craniovertebral junction is often abnormal in children with Crouzon’s syndrome, no study had measured accurately the size of their foramen magnum (FM). We compared the FM size (area, diameters) on computed tomography examination in 21 children with a genetically confirmed Crouzon’s syndrome prior to any surgery and in 23 control children without craniofacial abnormalities. We extrapolated the growth pattern in both groups. We found a statistically significant smaller FM area (p = 0.0228), FM sagittal diameter (p = 0.0287), and FM sagittal posterior diameter (p = 0.0023) in children with Crouzon’s syndrome. No differences were detected with regard to the transversal diameter. Hydrocephalus in children with Crouzon’s syndrome was associated with a small FM area (p = 0.05), small sagittal diameter (p = 0.023), small sagittal posterior diameter (p = 0.0173), and reduced transversal diameter (p = 0.03985). No association of the aforementioned findings was found with the position of the cerebellar tonsils or the lambdoid suture functional state (open or fused). Comparable results were observed among the two genetic forms (exon 8 or 10 mutations). Concerning the growth pattern, a first phase of rapid increase and a second phase of slow increase could be recognized in all the measurements in both populations, though with some significant differences. The growth of FM follows a biphasic pattern in both Crouzon’s and control children. The sagittal diameter and the global size of the FM are mostly affected in children with Crouzon’s syndrome. The small FM, especially its posterior part, is likely to play a key role in the physiopathology of hydrocephalus.

Anterior extraperitoneal exposures to the lumbar spine are being increasingly used owing to the expanding use of novel technologies to treat degenerative disc disease. Lumbar plexus injuries are potential, albeit uncommon, complications of such exposures and can lead to significant perioperative morbidity. In this report, we present three patients with thoracolumbar fractures who sustained isolated femoral nerve palsies after a mini-open extraperitoneal approach to the midlumbar spine was undertaken to perform a partial corpectomy. To further understand the pathophysiology of this nerve injury, we conducted a cadaveric experiment to evaluate the effect of performing this approach and the effect of hip positioning on linear displacement of the femoral nerve. The displacement of the femoral nerve during the anterolateral extraperitoneal exposure through a 4- to 6-cm incision was equal to 6.6% of the full femoral nerve length. Relaxation of the femoral nerve was equal to 25% of the full nerve length when the hip was flexed to 90 degrees in neutral abduction-adduction. We conclude that the anterolateral extraperitoneal exposure of the midlumbar spine can potentially stretch the femoral nerve beyond its physiologic limits, particularly in trauma cases where exposure of the lateral vertebral body necessitates substantial retraction of the psoas muscle. The avoidance of self-retaining retractors for prolonged periods of time and the positioning of the hip in flexion may help to avoid such nerve injuries.

International audience; Access to cerebral tissue is essential to better understand the molecular mechanisms associated with neurodegenerative diseases. In this study, we present, for the first time, a new tool designed to obtain molecular and cellular cerebral imprints in the striatum of anesthetized monkeys. The imprint is obtained during a spatially controlled interaction of a chemically modified micro-silicon chip with the brain tissue. Scanning electron and immunofluorescence microscopies showed homogeneous capture of cerebral tissue. Nano-liquid chromatography-tandem mass spectrometry (nano-LC-MS/MS) analysis of proteins harvested on the chip allowed the identification of 1158 different species of proteins. The gene expression profiles of mRNA extracted from the imprint tool showed great similarity to those obtained via the gold standard approach, which is based on post-mortem sections of the same nucleus. Functional analysis of the harvested molecules confirmed the spatially controlled capture of striatal proteins implicated in dopaminergic regulation. Finally, the behavioral monitoring and histological results establish the safety of obtaining repeated cerebral imprints in striatal regions. These results demonstrate the ability of our imprint tool to explore the molecular content of deep brain regions in vivo. They open the way to the molecular exploration of brain in animal models of neurological diseases and will provide complementary information to current data mainly restricted to post-mortem samples.

Objectif Cette etude a pour but d’etudier la repartition anatomique d’un colorant au sein du tronc cerebral en fonction du site d’implantation du catheter. Introduction Le gliome infiltrant du tronc cerebral de l’enfant est une pathologie incurable, une des raisons de l’echec du traitement medical est le faible passage transvasculaire du fait de la barriere hemato-encephalique. Une des methodes pour outrepasser cet obstacle est l’injection directe au sein du tronc cerebral. Nous avons etudie la diffusion au sein de la protuberance selon que l’injection etait faite au niveau du pedoncule cerebelleux moyen ou directement au niveau de la protuberance. Materiels et methodes Dix-neuf injections ont ete realisees, 12 dans le pedoncule cerebelleux moyen et 7 directement dans la protuberance. L’injection etait realisee a un debit de 0,1 mL/h pour un volume d’injection pouvant aller jusqu’a 23 mL. Resultats Aucune des injections dans le pedoncule cerebelleux n’a permis d’obtenir une coloration dans la protuberance, alors que les injections dans la protuberance ont permis une belle diffusion au sein du tronc cerebral sans coloration vers le pedoncule cerebelleux. Conclusion Alors que les biopsies stereotaxiques des gliomes infiltrants du tronc cerebral se font dans le pedoncule cerebelleux afin de diminuer les risques de la biopsie, il semble qu’une injection therapeutique doive etre realisee dans la protuberance pour atteindre son but.

Objectif Cette etude a pour objet de mettre en evidence des anastomoses directes entre la veine surrenale gauche et le systeme azygos. Le grand nombre de dissections nous a permis d’etablir une cartographie precise de cette region. Introduction Les ouvrages d’anatomie restent peu precis en ce qui concerne l’anatomie du l’arc reno-azygo-lombal (ARAL) et ses anastomoses potentielles avec la veine surrenale gauche (VSRG). L’ARAL et le siege de variations anatomiques et les possibles anastomoses avec la VSRG n’ont pas encore ete decrites precisement. Materiels et methodes Quarante-quatre cadavres formoles ont ete disseques entre novembre 2014 et octobre 2015 au laboratoire d’anatomie des Alpes francaises (LADAF), les corps ne devaient pas avoir d’antecedents surrenaliens ou de chirurgie retroperitoneale. Resultats Aucune anastomose directe n’a ete mise en evidence entre la veine surrenale gauche et l’ARAL, deux anastomoses (4,5 %) entre les veines de la capsule surrenalienne et le systeme azygos. Un tronc veineux lombo-azygos a pu etre trouve dans 38 cas (86,3 %) : 35 (79,5 %) se drainaient dans la veine renale gauche et 3 (6,8 %) dans la veine gonadique gauche. Dans l’ensemble des cas une veine phrenique inferieure s’abouchant dans la veine surrenalienne a ete mise en evidence, 6 fois (13,7 %) dans une veine surrenalienne double et 38 fois (86,3 %) dans une veine surrenalienne unique. Conclusions Ces resultats pourraient avoir des applications dans la chirurgie des pheochromocytomes et conforter l’idee qu’une ligature precoce de la veine surrenale est la technique la plus sure mais qu’elle ne suffit pas a controler un drainage accessoire par les veines phreniques. Cela confirme la possibilite d’une extension vers le mediastin des tumeurs lateralisees a gauche. De plus ces resultats peuvent laisser penser que les dosages realises selectivement sur la veine surrenale peuvent sous-estimer la realite.

International audience; Gliomas are extremely aggressive and lethal forms of brain cancer. Unlike many other cancer types, glioma cells rarely metastasize. They spread throughout the brain and invasiveness of glioma cells is a major cause of therapeutic failure. In plant ecosystem, biodiversity acts locally as a barrier to ecological invasion. By analogy, we hypothesize that the low cell diversity of differentiated tissues, a counterpart of their functional specificity, opens the way to local cancer cell invasion. Seeding the brain tumor microenvironment with heterogeneous cell populations could be a mean to limit cancer cell invasion by enhancing cell biodiversity.

International audience

Introduction En cas d’aplasie de coupole diaphragmatique, la fermeture directe du diaphragme est impossible. Le chirurgien peut soit utiliser une prothese non resorbable presentant un risque superieur de recidive, d’infection, voir de trouble musculo-squelettique, soit realiser un lambeau, notamment de muscle oblique interne (MOI) et de muscle transverse (MT), lambeau triangulaire, dont la base (axe de rotation) passe par l’extremite mediale de K11 (EMK11) et le processus xiphoide. Les etudes cliniques montrent un tonus preserve du lambeau, mais peuvent evoquer une hypotonie du muscle oblique externe (MOE) laisse en place. Objectif Etudier l’innervation du MOE, et du lambeau, par le 10 e nerf intercostal (10 e NIC). Materiel et methode Etude anatomique de l’innervation des muscles larges de l’abdomen par le 10 e NIC (nombre de branches nerveuses, trajet, naissance en amont ou en aval l’EMK11) a partir de la dissection de 40 hemi-parois thoraco-abdominales (20 droites, 20 gauches). Resultats Caudalement au diaphragme, le 10 e NIC est toujours situe entre le MOI et le MT. En moyenne, 9 branches innervent le MOE, 77 % naissant en aval de l’EMK11. En moyenne, 9 et 12 branches innervent respectivement le MOI et le MT. Conclusion Cette etude confirme la bonne innervation du lambeau de MOI et de MT, en faveur d’un tonus du lambeau preserve, et en faveur de la realisation d’un lambeau de MOI et de MT dans les aplasies de coupole diaphragmatique. Cependant 75 % des branches innervant le MOE issues du 10 e NIC sont sectionnees par le prelevement du lambeau, plaidant pour le renforcement de la paroi abdominale par la mise en place complementaire d’une prothese resorbable abdominale qui, par la fibrose provoquee et l’absence de retraction du MOE, limiterait le risque d’hypoplasie abdominale et ses consequences respiratoires chez des patients presentant tous une hypoplasie pulmonaire.

Objet La connaissance de la projection du plan des cordes vocales par rapport a des reperes externes serait un atout important, notamment dans le cadre des chirurgies de thyroplastie, pour le bon positionnement de la prothese par rapport au plan cordal car c’est un facteur important d’echec dans cette chirurgie [1] . Patients et methodes Une etude morphometrique sur 57 larynx (28 hommes et 29 femmes) a ete effectuee. Pour chaque larynx le plan des cordes vocales etait place en fonction de reperes externes sur le cartilage thyroide. Resultats Il est possible de placer le plan cordal en fonction de certains reperes externes facilement utilisables. Il existe une projection assez constante de la commissure anterieure par rapport a l’incisure thyroidienne superieure independamment du sexe. Il est possible de placer la projection du cartilage arytenoidien le long de la crete oblique en prenant en compte les variations existantes entre la droite et la gauche ainsi qu’entre hommes et femmes. Conclusions Nos resultats en ce qui concerne la projection de la commissure anterieure sont concordants avec la litterature [2] , l’originalite de cette etude est de fournir un moyen simple par des reperes anatomiques externes du cartilage thyroide de placer l’extremite posterieure des cordes vocales. Ces resultats peuvent permettre d’optimiser la precision de placement de la fenetre au niveau du cartilage thyroide dans les interventions de thyroplastie.