Tuberculosis infections caused by
Mycobacterium (
M.)
pinnipedii in a South American sea lion, Bactrian camel, and Malayan tapirs kept in two zoological gardens spanning a time period of 5 years are ...reported. The zoos were linked by the transfer of one tapir. Conventional bacteriological and molecular methods were applied to detect the pathogen. Spoligotyping and MIRU/VNTR-typing performed to assess the genetic similarity revealed identical molecular characteristics of the isolates from all animals involved. Anti-tuberculosis antibodies were detected using ELISA and a recently developed serological rapid test. The study shows that: (i) using molecular methods, the assessment of the genetic relationship of infectious agents helps to confirm the routes of infection, and that (ii) immunological tests may help to detect tuberculosis infections
ante mortem more reliably and early. This would prevent the transfer of tuberculosis by asymptomatic animals.
To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery.
Medical records of 72 women who developed either ...ductal carcinoma in situ or stage I-III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed.
Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40 Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%).
Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position.
Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We ...assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neoadjuvant chemotherapy and breast-conserving surgery.
Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neoadjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival.
All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio HR=3.05; 95% CI, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis (HR=2.24; 95% CI, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival.
Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neoadjuvant chemotherapy. These results need to be confirmed in a prospective study.
L’objectif de notre étude était d’évaluer les caractéristiques des cancers du sein survenant après un lymphome hodgkinien et notamment le pronostic après chirurgie conservatrice.
Il s’agit d’une ...étude rétrospective concernant 72 femmes qui ont vu se développer un cancer du sein in situ ou invasif de stade I–III après un lymphome de Hodgkin, entre 1978 et 2009.
L’âge médian au moment du diagnostic du lymphome de Hodgkin était de 23ans. La dose totale médiane reçue par le médiastin était de 40Gy, principalement par une technique en mantelet. Les cancers du sein sont survenus après un intervalle médian de 21ans après le lymphome de Hodgkin. Les carcinomes canalaires infiltrants et in situ représentaient respectivement 71 % et 19 % des cas. Le traitement locorégional des cancers du sein a comporté une mastectomie avec (3) ou sans (36) radiothérapie adjuvante chez 39 patientes et une tumorectomie avec (30) ou sans (2) ou sans radiothérapie adjuvante chez 32 patientes. La technique de décubitus latéral isocentrique a été utilisée chez 17 patientes (57 %). Avec un suivi en médiane de septans, les taux de survie globale et de contrôle locorégional à cinqans étaient respectivement de 74,5 % et 82 % pour les cancers invasifs et de 100 % et 92 % pour les cancers in situ. Treize patientes sont décédées d’une progression du cancer du sein et un cancer du sein controlatéral a été diagnostiqué chez dix patientes (14 %).
La chirurgie conservatrice peut être une option pour les cancers du sein survenant après lymphome de Hodgkin, malgré l’irradiation thoracique antérieure. Elle doit associer une mastectomie partielle et une irradiation avec utilisation d’une technique adéquate telle que le latéral isocentrique.
To report characteristics and outcome of breast cancer after irradiation for Hodgkin lymphoma with special focus on breast conservation surgery.
Medical records of 72 women who developed either ductal carcinoma in situ or stage I–III invasive carcinoma of the breast after Hodgkin lymphoma between 1978 and 2009 were retrospectively reviewed.
Median age at Hodgkin lymphoma diagnosis was 23 years old. Median total dose received by the mediastinum was 40Gy, mostly by a mantle field technique. Breast cancer occurred after a median time interval of 21 years. Ductal invasive carcinoma and ductal carcinoma in situ represented respectively 71% and 19% of the cases. Locoregional treatment for breast cancer consisted of mastectomy with or without radiotherapy in 39 patients and of lumpectomy with or without adjuvant radiotherapy in 32 patients. The isocentric lateral decubitus radiation technique was used in 17 patients after breast conserving surgery (57%). With a median follow-up of 7 years, 5-year overall survival rate and locoregional control rate were respectively 74.5% and 82% for invasive carcinoma and 100% and 92% for in situ carcinoma. Thirteen patients died of progressive breast cancer and contralateral breast cancer was diagnosed in ten patients (14%).
Breast conserving treatment can be an option for breast cancers that occur after Hodgkin lymphoma despite prior thoracic irradiation. It should consist of lumpectomy and adjuvant breast radiotherapy with use of adequate techniques, such as the lateral decubitus isocentric position.
Le down-staging tumoral après chimiothérapie néoadjuvante pourrait modifier les indications d’irradiation adjuvante des aires ganglionnaires. L’objectif était d’évaluer l’intérêt de l’irradiation des ...aires ganglionnaires chez les patientes atteintes d’un cancer du sein sans envahissement ganglionnaire (pN0) après chimiothérapie néoadjuvante et chirurgie mammaire conservatrice.
Parmi 1054 patientes prises en charge entre 1990 et 2004 par chimiothérapie néoadjuvante pour un cancer du sein, 248 (23,5 %) étaient indemnes d’envahissement ganglionnaire après chimiothérapie néoadjuvante et chirurgie mammaire conservatrice. Les survies sans récidive locorégionale, sans maladie et globale ont été analysées en fonction de l’irradiation ou non des aires ganglionnaires.
Toutes les patientes (248) ont reçu une irradiation mammaire, associée pour 158 (63,7 %) d’entre elles à une irradiation adjuvante des aires ganglionnaires. Après un suivi médian de 88 mois, les taux de survie sans récidive locorégionale et de survie globale à cinq ans étaient respectivement de 89,4 % et 88,7 % avec irradiation adjuvante des aires ganglionnaires et 86,2 % et 92 % sans irradiation adjuvante des aires ganglionnaires (NS). En analyse multifactorielle, l’absence de réponse histologique complète de la tumeur (hazard ratio HR=3,05 ; intervalle de confiance à 95 % IC 95 %, 1,17 à 7,99 ; p=0,023) et le statut cN1-N2 lors du diagnostic (HR=2,24 ; IC 95 %, 1,15 à 4,36 ; p=0,017) étaient associés à une diminution de la survie globale. L’absence d’irradiation adjuvante des aires ganglionnaires n’avait d’effet délétère ni sur la survie sans maladie ni sur la survie globale.
Nos résultats suggèrent que l’irradiation mammaire seule ne serait pas associée à un risque plus élevé de récidive locorégionale ou de décès chez les patientes atteintes d’un cancer du sein classé pN0 après chimiothérapie néoadjuvante.
Neoadjuvant chemotherapy generally induces significant changes in the pathological extent of disease. This potential down-staging challenges the standard indications of adjuvant radiation therapy. We assessed the utility of lymph node irradiation in breast cancer patients with pathological N0 status (pN0) after neoadjuvant chemotherapy and breast-conserving surgery.
Among 1054 breast cancer patients treated with neoadjuvant chemotherapy in our institution between 1990 and 2004, 248 patients with clinical N0 or N1-N2 lymph node status at diagnosis had pN0 status after neoadjuvant chemotherapy and breast-conserving surgery. Cox regression analysis was used to identify factors influencing locoregional recurrence-free survival, disease-free survival and overall survival.
All 248 patients received breast irradiation, and 158 patients (63.7%) also received lymph node irradiation. With a median follow-up of 88 months, the 5-year locoregional recurrence-free survival and overall survival rates were respectively 89.4% and 88.7% with lymph node irradiation and 86.2% and 92% without lymph node irradiation (no significant difference). Survival was poorer among patients who did not have a pathological complete primary tumor response (pCR) (hazards ratio HR=3.05; 95% CI, 1.17 to 7.99) and in patients with N1-N2 clinical status at diagnosis (HR=2.24; 95% CI, 1.15 to 4.36). Lymph node irradiation did not significantly affect survival.
Relative to combined breast and local lymph node irradiation, isolated breast irradiation does not appear to be associated with a higher risk of locoregional relapse or death among breast cancer patients with pN0 status after neoadjuvant chemotherapy. These results need to be confirmed in a prospective study.
A colony of 26 chimpanzees given a fruit and vegetable diet of very low Na and high K intake were maintained in long-standing, socially stable small groups for three years. Half of them had salt ...added progressively to their diet during 20 months. This addition of salt within the human dietetic range caused a highly significant rise in systolic, mean and diastolic blood pressure. The change reversed completely by six months after cessation of salt. The effect of salt differed between chimpanzees, some having a large blood pressure rise and others small or no rise. These results in the species phylogenetically closest to humans bear directly on causation of human hypertension, particularly in relation to migration of preliterate people, with low Na diet, to a Western urban lifestyle with increased salt intake. The hedonic liking for salt and avid ingestion was apt during human prehistory involving hunter-gatherer-scavenger existence in the interior of continents with a scarcity of salt, but is maladaptive in urban technological life with salt cheap and freely available.
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