Étudier la faisabilité de la salpingectomie prophylactique lors d’hystérectomies par voie vaginale d’indication bénigne et la prévalence des lésions tubaires occultes.
Étude prospective monocentrique ...réalisée du premier septembre 2013 au premier novembre 2014 évaluant la prévalence des salpingectomie bilatérale exclusive ou en association avec une ovariectomie et des anomalies histopathologiques tubaires (morphologiques ou immunohistochimiques à l’aide du marqueur p53).
Soixante-neuf patientes ont été incluses. La technique chirurgicale la plus utilisée était la ligature du mésosalpinx par une endoloop ou un fil. La salpingectomie a été faisable dans 51cas (73,9 %). Seul l’IMC élevé était statistiquement associé au taux d’échec de la salpingectomie (29,4 vs 25, 8 ; p=0,01). Une seule complication postopératoire (hémopéritoine) est survenue dans le groupe salpingectomie. Sur les 51paires de trompes analysées, 4 (12,9 %) anomalies immunohistochimiques (signature p53) ont été visualisées.
L’origine tubaire récemment démontrée du cancer de l’ovaire a logiquement posé la question de la salpingectomie préventive exclusive dans les groupes à risque génétique et dans la population générale afin d’éviter la ménopause chirurgicale induite. La salpingectomie par voie vaginale apparaît réalisable chez des opérateurs expérimentés. La présence d’anomalies immunohistochimiques, d’évolution inconnue, doit malgré tout inciter à la circonspection.
To assess the feasibility of prophylactic salpingectomy during vaginal hysterectomy for benign pathology and the prevalence of occult tubal lesions.
In this prospective study from 09/01/2013 to 11/01/2014, patients who underwent vaginal hysterectomy with salpingectomy or salpingo-oophorectomy were included. The prevalence of bilateral salpingectomy with or without ovariectomy and the prevalence of histopathological and immunohistochemical (p53 expression) abnormalities were evaluated.
Bilateral salpingectomy was performed in 51/69 patients (73.9%). An elevated BMI was statistically associated with a failure of the salpingectomy (29.4 vs 25.8; P=0.01). There was only one case of postoperative hemorrhage in the salpingectomy group. On the 51fallopian tubes, there were 4 (12.9%) immunohistochemical abnormalities “p53 signature”.
The recent tubal origin of most ovarian cancer cases raised the question of the prophylactic salpingectomy in the population with genetic risk as well as in the general population. Bilateral salpingectomy may be performed during vaginal hysterectomy. However caution is needed because we do not know what is the exact evolution of the p53 signatures.
We report a case of anophthalmia discovered after birth and discuss the need to resolve diagnostic difficulties and determine prognosis. This is an exceptional malformation which is particularly ...difficult to manage. It often occurs in the context of a complex malformation syndrome. Recent imaging techniques including magnetic resonance imaging help determine the degree of malformation and provide useful information for giving genetic advice to parents.
Lymph node metastases in cervical and endometrial cancer are major prognostic factors. Lymph-nodal involvement determines adjuvant therapy. As imagery is not reliable to diagnose lymph node status, ...pelvic +/- para-aortic lymphadenectomy remains the gold standard. These surgical procedures are, however, responsible for specific morbidity: lymphocele and lymphedema. Sentinel lymph node procedure could avoid lymphadenectomy and their complications in cervical and endometrial cancer with good negative predictive values. We present actual indications, procedure and results of sentinel lymph node procedures in cervical and endometrial cancer.
We have measured the neutron structure function
g
2
n
and the virtual photon-nucleon asymmetry
A
2
n
over the kinematic range 0.014 ⩽ × ⩽ 0.7 and 1.0 ⩽
Q
2
⩽ 17.0 by scattering 48.3 GeV ...longitudinally polarized electrons from polarized
3He. Results for
A
2
n
are significantly smaller than the √
R positivity limit over most of the measured range and data for
g
2
n
are generally consistent with the twist-2 Wandzura-Wilczek prediction. Using our measured
g
2
n
we obtain results for the twist-3 reduced matrix element
d
2
n
, and the integral ∫
g
2
n
(
x)
dx in the range 0.014 ⩽ × ⩽ 1.0. Data from this experiment are combined with existing data for
g
2
n
to obtain an average for
d
2
n
and the integral ∫
g
2
n
(
x)
dx.
La présence de métastases ganglionnaires dans les néoplasies du col et du corps de l’utérus est un facteur pronostique primordial. Le statut ganglionnaire participe aux indications du traitement ...adjuvant de ces cancers. L’imagerie ayant des valeurs diagnostiques insuffisantes, la lymphadénectomie pelvienne +/− lombo-aortique est jusqu’à présent la référence pour l’établissement du statut ganglionnaire. Les curages sont cependant source de morbidité propre : lymphocèle et lymphœdème. Le développement de la procédure du ganglion sentinelle (GS) pourrait permettre d’éviter des lymphadénectomies et leurs complications propres dans la prise en charge des cancers utérins avec de très bonnes valeurs prédictives négatives. Nous développons ici les actuelles indications, techniques et résultats de la procédure du GS dans les cancers du col de l’utérus et de l’endomètre.
Lymph node metastases in cervical and endometrial cancer are major prognostic factors. Lymph-nodal involvement determines adjuvant therapy. As imagery is not reliable to diagnose lymph node status, pelvic +/- para-aortic lymphadenectomy remains the gold standard. These surgical procedures are, however, responsible for specific morbidity: lymphocele and lymphedema. Sentinel lymph node procedure could avoid lymphadenectomy and their complications in cervical and endometrial cancer with good negative predictive values. We present actual indications, procedure and results of sentinel lymph node procedures in cervical and endometrial cancer.
Living cells from the urinary tract can be examined by phase-contrast microscopy in a pellet obtained by centrifugation of 10 ml of freshly voided urine. Once these cells have been identified and ...classified according to their sources, their respective proportions can be evaluated, thus providing some information on the renal structures affected. Urine sediment examination was performed in 60 cases of acute renal failure in order to determine the relationship between the abnormalities encountered and the clinical or histological diagnosis. An abnormal sediment was always associated with parenchymal acute renal failure. Cellular debris and casts were abundant in acute tubular necrosis and less numerous in toxic acute renal failure than in failure resulting from shock. The finding of deformed erythrocytes was strongly suggestive of glomerular nephropathy, a diagnosis which was confirmed by renal biopsy in almost every case.
Élaborer une collection biologique réunissant des échantillons de qualité optimale pour inciter la recherche fondamentale sur les maladies trophoblastiques gestationnelles (MTG).
Trois axes ...prioritaires de recherche ont été définis afin d’optimiser la nature, les conditions de prélèvement et de stockage des échantillons biologiques de patientes atteintes de MTG au sein d’une biobanque dédiée : la compréhension de la physiopathologie des MTG, le développement de nouveaux outils diagnostiques et l’identification de nouvelles cibles thérapeutiques. Le protocole d’inclusion de chaque patiente a été élaboré à la lumière d’une revue extensive de la littérature et d’échanges avec de nombreux experts internationaux en recherche sur les MTG.
Cette biobanque rassemble ainsi pour chaque patiente des échantillons tissulaires (frais, conservés en RNALater® et fixés en formol), sanguins (sérum, plasma, ARN sanguin et lymphocytes sanguins), urinaires (surnageants) ainsi que des cultures cellulaires sélectives de cytotrophoblastes villeux. Les échantillons sont collectés prospectivement et sont associés à de nombreuses données cliniques et biologiques dont la décroissance de l’hormone chorionique gonadotropique sanguine en cas de môle hydatiforme.
La qualité des échantillons et des données cliniques constituant cette biobanque ouvre la possibilité de nombreux projets de recherche dans le cadre de collaborations scientifiques nationales et internationales.
To generate a national biobank made up of samples of the highest quality for the purpose of inciting basic research on gestational trophoblastic diseases (GTD).
Three priority axes of research were defined to optimize the nature, method of collection, and storage of the samples. These are: to enhance our understanding of GTD, develop new diagnostic tests, and identify new therapeutic targets. The protocol for patient inclusion and sample processing was determined after extensive literature review and collaboration with international experts in the field of GTD.
For each patient with a GTD and for control patients (legally induced abortions), chorionic villi, decidua and tumor samples (fresh, immersed in RNA-protective solution and fixed in formaldehyde), blood (serum, plasma, RNA, and peripheral blood mononuclear cells), urine (supernatant), and cell cultures of villous cytotrophoblasts are prospectively collected. Associations are then made between the collected samples and numerous clinical and biological data, such as human chorionic gonadotropic plasma levels following curettage in the case of a hydatidiform mole.
Such a collection of high quality samples and their associated data open up new perspectives for both national and international collaborative research projects.
Phase contrast examination of urine sediment of patients with the nephrotic syndrome shows cytolipiduria in 62.8% of cases. Cytolipiduria is mostly observed in patients between 20 and 80, and is, in ...most cases, associated to cytological features of glomerular and/or tubular injury. In absence of cytolipiduria, renal biopsy most often shows minimal change disease. Membranous glomerulonephritis is observed in most cases with high cytolipiduria. However, urine sediment is not predictive of renal histologic lesions and progressive glomerulonephritis can be observed in absence of cytolipiduria.
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