Significance of a new fluorodeoxyglucose-positive lesion on restaging positron emission tomography/computed tomography after induction therapy for non-small-cell lung cancer †

OBJECTIVES Restaging of patients with locally advanced non-small-cell lung cancer (NSCLC) is of paramount importance, since only patients with down-staging after induction therapy will benefit from surgery. In this study, we assessed the aetiology of new 18fluoro-2-deoxy-d-glucose (FDG)-positive focal abnormalities on restaging positron emission tomography/computed tomography (PET/CT) in patients with a good response after induction chemotherapy in the primary tumour and lymph nodes. METHODS Between 2004 and 2008, 31 patients with histological proven stage III NSCLC had a PET/CT prior and after induction chemotherapy. Their medical charts were retrospectively reviewed. RESULTS Restaging PET/CT revealed a new FDG-positive lesion in 6 of 31 (20%) patients. The initial clinical stage of the disease was IIIA N2 in four and IIIB T4 in two patients. The maximal standard uptake value in the primary tumour (P=0.043) and in the initially involved mediastinal nodes (P=0.068) decreased after induction treatment in all patients. The new PET/CT findings were located in an ipsilateral cervical lymph node in two patients, a contralateral mediastinal in one patient and an ipsilateral mammary internal lymph node in one patient. Two other patients had a lesion on the contralateral lung. Malignant lymph node infiltrations were excluded following fine-needle puncture, intraoperative biopsy or follow-up PET/CT. Contralateral pulmonary lesions were diagnosed as benign following mini thoracotomy and pulmonary wedge resection. CONCLUSIONS New solitary FDG-positive lesions on restaging PET/CT after induction chemotherapy for NSCLC are not rare in good responders to chemotherapy. In our experience, all these lesions were not associated with malignanc

Increase in Bone Mineral Density after Successful Parathyroidectomy for Tertiary Hyperparathyroidism after Renal Transplantation

Background: Few studies have reported changes of bone mineral density (BMD) after parathyroidectomy in patients with persistent hyperparathyroidism after renal transplantation (3 HPT). Patients and Methods: We retrospectively analyzed 14 patients who underwent successful parathyroidectomy for 3 HPT and who had available BMD data before and after parathyroidectomy. Results: Median follow-up time was 26months (IQR: 16.8-40.2). Serum calcium levels decreased significantly after parathyroidectomy (2.32 ± 0.09 versus 2.66±0.16mmol/l; p<0.01), as did PTH levels (5.1±3.0 versus 27.8±23.7pmol/l; p<0.01). Nine patients (64%) had a steroid-free immunosuppression at follow-up. Mean increase in BMD was 9.5±8.0% for the spine and 9.5±7.9% for the hip (p<0.01 for both sites). Patients with osteoporosis (T-score ≤ 2.5) or osteopenia (T-score ≤ 1) before parathyroidectomy had the biggest increase in BMD (10.7±7.7% in hip BMD and of 12.3±8.1% in spine BMD). Conclusions: Parathyroidectomy is an efficient treatment of osteoporosis and osteopenia in patients with 3 HP

Survie selon le type d'atteinte résiduelle microscopique de la marge bronchique après résection pulmonaire pour cancer non à petites cellules

Etude rétrospective comparant la survie des patients avec présence de tumeur résiduelle microscopique à celle des patients avec résection complète d'un NSCLC. Résultats: les patients avec stade tumoral I et II et tumeur résiduelle limitée à la muqueuse ou au niveau péri-bronchique se comportent de manière analogue aux patients avec résection complète. Au contraire, les patients avec atteinte sous-muqueuse ou lymphatique n'ont aucun survivant à 5 ans. Il n'existe pas de différence de survie entre les patients avec résection complète et incomplète lorsque le stade tumoral est III ou IV. Conclusion: les patients au stade tumoral I et II avec atteinte résiduelle tumorale sous-muqueuse ou lymphatique devraient bénéficier d'un traitement d'éradication du résidu, car ce dernier péjore la survie. Au contraire, en cas de stade tumoraux III et IV, la survie semble être plus en relation avec ces derniers qu'avec la présence de résidu tumoral

Asplénie congénitale (Syndrome d'Ivemark révélée par une thrombose veino-mésentérique chez un malade de 77 ans

Congenital asplenia (Ivemark syndrome) is usually associated with major cardiac malformations, which determine the clinical presentation and often result in death before 6 months of age. We report the unusual case of a 77 year-old patient with a congenital asplenia that was incidentally detected during a laparotomy for mesenteric vein thrombosis. The other abnormal findings in the abdomen were a para-esophageal hiatal hernia and left kidney hypotrophy. A segmental resection of the mid-jejunum was performed, with uneventful recovery. A thoraco-abdominal CT scan failed to reveal any associated vascular malformations in the retroperitoneum or the thorax. This case suggests that, in some instances, congenital asplenia, when isolated, may remain asymptomatic and be compatible with a long, and functionally normal life

Clinical evaluation of bioadhesive hydrogels for topical delivery of hexylaminolevulinate to Barrett's esophagus

Fluorescence diagnosis following oral administration of 5-aminolevulinic acid (5-ALA) has shown to enable the sensitive visualization of intestinal metaplasia, dysplasia and early carcinoma in Barrett's esophagus. Once being established, this technique will be a potential alternative to today's standard diagnosis, i.e. four-quadrant random biopsies which are taken every 1-2 cm of the esophagus for histopathological analysis. In order to further improve this methodology, topical application of lipophilic 5-ALA esters to the esophagus could be advantageous in terms of fluorescence contrast and fluorescence intensity in the target tissue, adverse side effects, as well as application time. Therefore, the aim of this study was to develop a bioadhesive formulation loaded with hexylaminolevulinate (HAL) targeting the esophageal lining. In the present study, different mucoadhesive gels including poloxamer 407, cross-linked polyacrylic acid, hydroxypropylmethylcellulose, sodium carboxymethylcellulose and chitosan have been evaluated with respect to bioadhesion to the esophagus using an ex vivo rat model and a clinical study on healthy volunteers. In order to visualize the mucoadhesive properties of the formulations, a blue dye was incorporated as contrast agent. Chitosan has shown the best esophageal adhesion both in vitro and in vivo. Furthermore, using the in vitro release profiles from chitosan loaded with 40 mM of HAL, one can estimate that after a residence time of 10 min on the esophageal wall, the amount of HAL delivered to the epithelium will be sufficient to perform fluorescence diagnosis of Barrett's esophagus following swallowing of this formulation

Maladie de Crohn révélée par une sténose duodénale. Stratégie chirurgicale

Crohn's disease may involve any part of the alimentary tract, including the stomach and duodenum. We report herein the case of a 22 year-old male in whom Crohn disease was diagnosed due to weight loss in relation with a stenosis of the first and second parts of the duodenum. A gastrojejunostomy was performed with a good subsequent result. The initial management of a Crohn's disease with involvement of the duodenum is medical. When there is an indication for surgery, a gastroenterostomy is preferred, albeit with a high incidence of outlet obstruction and marginal ulceration

Survival according to the site of bronchial microscopic residual disease after lung resection for non-small cell lung cancer

OBJECTIVE: We performed a retrospective study evaluating the effect on survival of different sites of microscopic residual disease at the bronchial resection margin after surgical intervention for non-small cell lung cancer. METHODS: Survival of patients with different sites of residual disease was compared with survival of patients with curative resections, taking the pathologic TNM stage of the tumor into consideration. RESULTS: There was a trend for patients with stage I and II non-small cell lung cancer with residual disease limited to the epithelium and with peribronchial invasion to behave like patients with complete resections (61% and 41% five-year survival for stage I and II disease, respectively). This contrasts with patients with submucosal invasion and lymphatic infiltration, among whom there were no survivors at 5 years. There was no difference in survival between curative resections and residual disease of any type when the tumor was stage III or IV. CONCLUSIONS: In patients with stage I and II disease, when residual disease consists of submucosal invasion or lymphatic infiltration, specific and aggressive treatments to clear residual margins might be contemplated because of their possible adverse effect on survival. This contrasts with patients with stage III and IV disease, in whom survival is more related to the stage of the primary tumor than to residual disease

Optimal management of thymic malignancies: current perspectives

International audienceThymic epithelial tumors (TETs) belong to orphan oncology. The incidence of TETs is about 1.3-3.2 cases per million worldwide. Following pathology, evolution and prognosis are variable. The World Health Organization classification distinguishes thymomas and thymic carcinomas. TETs are composed of thymic epithelial tumoral cells and normal lymphocytes. The mean age at diagnosis is 50-60 years-old. There are no identified risk factors. TETs are frequently associated with paraneoplastic syndromes as myasthenia gravis. The complete R-0 surgical resection is the most significant prognosis factor on survival. In 2010, the French National Institute of Cancer labeled the RYTHMIC network as a specific tumor board including thoracic surgeons, oncologist, and radiation therapist to define standard of care for the management of TETs. The aim of the review was to update knowledge to optimize the standard of care