Différentes techniques ont été proposées pour corriger la ptose des téguments du tiers moyen de la face. Nous avons quant à nous développé notre propre technique de lifting sous-périosté ...temporomalaire. De façon à présenter cette technique et à évaluer ses indications, ses risques et ses résultats, nous avons réalisé une étude rétrospective des patientes ayant bénéficié de ce type d'intervention dans le service entre mars 2002 et janvier 2006. Cette étude a porté sur 69 patientes, âgées de 46 ans en moyenne (42 et 65 ans). Nous avons revu leurs dossiers et analysé les critères de sélection de ces patientes, les complications postopératoires, ainsi que les résultats esthétiques. Toutes les patientes présentaient en préopératoire des sillons nasogéniens marqués, et 71
% d'entre elles des poches malaires. Aucune ne présentait de ptose des téguments à l'étage cervical. Il s'agissait dans 21 cas d'une reprise de lifting cervicofacial. L'intervention s'est compliquée dans huit cas (quatre cas de parésie réversible de la branche temporale du nerf facial, un cas de parésie réversible du nerf sous-orbitaire, un cas d'asymétrie, un cas d'œil rond, et un ectropion). Les résultats esthétiques étaient satisfaisants, avec un recul de deux ans et huit mois en moyenne, avec dans tous les cas des sillons nasogéniens moins marqués et dans 80
% des cas une diminution de la hauteur de la paupière inférieure. Aux vues des résultats, on peut conclure que le lifting temporomalaire corrige de façon satisfaisante et stable la ptose des téguments du tiers moyen du visage.
The subperiosteal face-lift is a procedure designed to rejuvenate the middle third of the face. We present in this study the technical procedure we have developed, based on the subperiosteal detachment of the soft tissues of the midface and their attachment to the deep temporal fascia with a vertical vector of suspension. We reviewed 69 patients who undergone superiosteal temporomalar rhytidectomy, between March 2002 and January 2006, ranged in age from 42 to 65 years (mean 46). All of the patients presented preoperatively prominents nasolabial folds, malar fat pad ptosis. None of them presented a cervical soft tissue ptosis. The mean follow-up period was 32 months. The postoperative complication rate was 11.5 percent and included transient temporal branch weakness (
N
=
4), transient infraorbital nerve paresthesia (
N
=
1), asymmetrical result (
N
=
1)
; scleral show (
N
=
1) and ectropion (
N
=
1) which required a secondary surgery. The overall aesthetic results were good; with attenuation of the prominent nasolabial folds in 100 percent and diminution of the height of the lower eyelid in 80 percent of the patients. In conclusion, the subperiosteal midace lift is a procedure designed to rejuvenate the middle third of the face.
La Dystrophie Musculaire de Duchenne (DMD) est une pathologie génétique récessive fatale liée au chromosome X. Elle atteint les hommes et son incidence est d’une naissance sur 3 500. Elle se ...caractérise dans le muscle squelettique par une dégénération musculaire progressive et une nécrose des fibres musculaires. Les conséquences pour les patients sont multiples. Dès l’âge de 12 ans, ils ne peuvent plus se déplacer que dans une chaise roulante et leur espérance de vie n’excède pas 20 ans en raison de graves complications respiratoires et cardiaques. La DMD est liée à l’absence d’une protéine sous-membranaire, la dystrophine, qui fait partie d’un complexe moléculaire DGC (Dystrophin-associated Glycoprotein Complex) composé d’éléments extracellulaires, membranaires et cytosoliques. Cette association réalise un lien structural indispensable entre la cellule et la matrice extracellulaire lors du processus d’excitation-contraction. Comme la dystrophine est sous-membranaire, son absence provoque des réorganisations spatiales protéiques importantes. L’objectif de notre étude est de visualiser ces réarrangements structuraux au moyen de la Microscopie de Conductance Ionique à Balayage (ou Scanning Ion Conductance Microscopy). Cette technique est basée sur la capacité d’une micropipette à balayer la surface d’une cellule tout en restant à une distance constante de la membrane plasmique. Les mouvements verticaux de la pipette au-dessus de la cellule, nécessaires pour maintenir une distance constante, permettent de construire la topographie membranaire. Nous avons d’abord travaillé sur des cardiomyocytes ventriculaires fraîchement dissociés de souris mâles BL10 saines et âgées, pour comparer nos résultats à ce qui a déjà été publié sur le rat. Les myocytes ont été isolés par la technique de Langendorff puis scannés par le SCIM. Dans les préparations « contrôle », nous retrouvons des invaginations membranaires se répétant avec régularité tous les 2 μm environ comme observés chez le rat (Gorelik et al, 2006). Les cardiomyocytes ventriculaires de souris mâles BL10 mdx (modèle animal de la DMD), et âgées présentant une cardiomyopathie dilatée sont en cours d’étude pour déterminer s’il existe des différences topographiques avec les cellules « contrôle », résultant du manque de dystophine. Julia Gorelik et al, Cardiovascular Research, 72 (2006) 422-429.
Résumé
La prise orale des comprimés ou des gélules est sou-vent difficile en cas de nausées, de vomissements, de dyspha-gies, de troubles de la déglutition… Cependant, des galéniques spécifiques ...existent. nous proposons un guide de prescription en cas de voie digestive haute altérée. Notre source est la base de données Vidal Hoptimal 2010. Les médicaments sont classés par classe thérapeutique, forme galénique, dénomination commune internationale (DCI), spécialité.
Aim
Little is known about patterns of recurrence in obstructing colon cancer (OCC) at a population level. The aim of this study was to determine the risk of recurrence following potentially curative ...surgery in OCC compared with that in uncomplicated colon cancer (CC).
Method
Data were obtained from the population‐based digestive cancer registry of Burgundy (France). Local and distant failure rates were calculated using actuarial methods. A multivariate analysis was performed using a Cox model.
Results
Obstructing colon cancer represented 8.5% of all colon cancers resected with curative intent (n = 3375). The 5‐year cumulative local recurrence rate was 14.2% for OCC and 7.6% for nonobstructing CC (P = 0.003). In the multivariate analysis, obstruction was an independent risk factor for local recurrence hazard ratio 1.53 (1.01–2.34), P = 0.047. The risk of local recurrence increased with advanced stage and age at diagnosis. The 5‐year cumulative rate for distant metastases was also higher in OCC than in nonobstructing CC (36.1 vs 23.1%; P < 0.001). The relative risk of distant metastasis was borderline significant in the multivariate analysis hazard ratio 1.25 (0.99–1.59), P = 0.057. Stage at diagnosis, macroscopic type of growth, period of diagnosis and sex were also significant prognostic factors. Age and subsite were not significant in the multivariate analysis.
Conclusion
It is possible to conduct special surveys in population‐based registries to determine the recurrence rate of CC. Recurrence remains a substantial problem and is more frequent in OCC than in nonobstructing CC. Efforts must be made to diagnose CC earlier. Mass screening is a promising approach.
SUMO-modification of nuclear proteins has profound effects on gene expression. However, non-toxic chemical tools that modulate sumoylation in cells are lacking. Here, to identify small molecule ...sumoylation inhibitors we developed a cell-based screen that focused on the well-sumoylated substrate, human Liver Receptor Homolog-1 (hLRH-1, NR5A2). Our primary gene-expression screen assayed two SUMO-sensitive transcripts, APOC3 and MUC1, that are upregulated by SUMO-less hLRH-1 or by siUBC9 knockdown, respectively. A polyphenol, tannic acid (TA) emerged as a potent sumoylation inhibitor in vitro (IC50 = 12.8 µM) and in cells. TA also increased hLRH-1 occupancy on SUMO-sensitive transcripts. Most significantly, when tested in humanized mouse primary hepatocytes, TA inhibits hLRH-1 sumoylation and induces SUMO-sensitive genes, thereby recapitulating the effects of expressing SUMO-less hLRH-1 in mouse liver. Our findings underscore the benefits of phenotypic screening for targeting post-translational modifications, and illustrate the potential utility of TA for probing the cellular consequences of sumoylation.
The aim of this study was to report on malignant digestive endocrine tumours (MDET) prognosis in several European countries. We analysed survival data from 19 cancer registries in 12 European ...countries on 3,715 MDET diagnosed between 1985 and 1994. The overall 5‐year survival rate was 47.5%. It was 58.1% for differentiated MDET and 8.1% for small‐cell MDET (p < 0.001), 55.9% for patients under 65 and 37.0% for older patients. Survival rates for small intestinal and colorectal were higher than for the other sites. The 5‐year relative survival rates were 60.3% in Northern Europe, 53.6% in Western Continental Europe, 42.5% in the UK, 37.6% in Eastern Europe (p < 0.001). Among well‐differentiated pancreatic tumours, 5‐year relative survival was 55.6% for insulinoma, 48.4% for gastrinoma, 33.4% for glucagonoma, 28.8% for carcinoïd tumours and 49.9% for non‐functioning tumours. The relative excess risk of death was significantly lower in Western Continental Europe and Northern Europe and significantly higher in Easter European compared to the UK. MDET differentiation, site, geographic area, age and sex, were independent prognostic factors. Overall, in Europe approximately half of the patients with MDET survive 5 years after the initial diagnosis. Prognosis varies with tumour differentiation, anatomic site and histological type. There are significant differences in survival from MDET among European countries, independently of other prognostic factors.
The aim of this study was to report on changes in the diagnostic assessment, patterns of care and survival over time for pancreatic cancers.
A total of 2986 cases of pancreatic cancer from the ...Digestive Cancer Registry of Burgundy (France) over a 30-year period (1976-2005) were considered. Non-conditional logistic regressions were carried out to identify the factors associated with resection for cure and with the use of chemotherapy. A multivariate relative survival analysis was carried out.
Diagnostic procedures have changed. Ultrasonography and computed tomography progressively have become the major diagnostic procedures. There was a slight improvement in stage: the proportion of stage I-II was 2.8% in the 1976-1980 period and 8.8% in the 2001-2005 period (P<0.001). There was a similar trend in the proportion of cases resected for cure, the corresponding percentages being 4.5 and 11.3%, respectively (P<0.001). The 5-year relative survival increased from 2.0 to 4.2% (P<0.001). In the multivariate relative survival analysis, the period remained a significant prognostic factor. Stage, sex, age and histology were independent prognostic factors.
Over a 30-year period, there were minor changes in the stage at diagnosis, resection for cure and prognosis of pancreatic cancers, although there were improvements in the diagnostic modalities. Pancreatic cancer still represents a major challenge in oncology.
Background:: Little is known about the management of recurrences from colorectal cancer at a population level. Materials and methods:: Data was obtained from the population-based cancer registry of ...Côte d'Or (Burgundy, France) over a 28-year period. Univariate and multivariate analyses were performed to analyse trends in treatment and survival for local recurrence and distant metastases. Results:: The proportion of patients resected for cure increased from 6.7% (1976–1984) to 23.7% (1994–2003; P <0.001) for distant metastases and from 15.9% to 58.1% (P <0.001) for local recurrence. Age and period of diagnosis were independent factors associated with a resection for cure. Rectal cancer local recurrence was less often resected for cure than colon cancer local recurrence (P=0.05). Long-term survival was observed only after resection for cure: 5-year relative survival rates were 36.1% for local recurrence and 24.0% for distant metastases. In the multivariate analysis, survival decreased with age and increased over time but significantly only over the last study period. Surgical resection and palliative chemotherapy were other determinants of prognosis for distant metastases whereas surgical resection and palliative radiotherapy did influence the prognosis for local recurrence. Conclusion:: Substantial advances in the management of recurrences have been achieved over time. More effective treatments and mass screening represent promising approaches to decrease this problem.
Stereotactic radiotherapy is an ever more common technique, regardless of the location treated. However, spinal stereotactic radiotherapy requires a particular technicality in order to ensure its ...proper realization. There is now a large literature defining the type of imaging to be used, the dose to be delivered and the delineation of target volumes. This technique can achieve a significant local control and an interesting analgesic efficiency. However, its place in relation to conventional radiotherapy remains limited because it requires MRI imaging and a significantly longer patient management during the treatment fraction. In this context, it is currently mainly restricted to oligometastatic patients or for re-irradiations.
Abstract Colorectal cancer is a major problem in elderly patients. Most data on the management and survival of colorectal cancer has been provided by specialised hospital units and as such cannot be ...used as reference because of unavoidable selection bias. Cancer registries recording data on treatment and survival at a population level represent the best valuable resource to assess the management of patients. However, there is a paucity of reports published in the literature due to the difficulty to routinely collect such data. Relative survival rates in the elderly were lower than in younger patients. However, the gap that has separated younger from elderly patients is closing. Stage at diagnosis remains the major determinant of prognosis. There is also large variation in survival within countries: survival rates being dramatically lower in Eastern European countries, compared to Western European countries. Comorbidity, which is particularly frequent in the elderly, increases the complexity of cancer management and affects survival. Substantial improvement in the care of colorectal cancer in the elderly has been achieved (increase in the proportion of patients resected for cure, decrease in operative mortality, improvement in stage at diagnosis). Surgery should not be restricted on the basis of age alone. Further improvements can be made, in particular with respect to adjuvant therapy.
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