Suivi dermatologique et tumeurs cutanées des greffés rénaux du CHU de Grenoble

Le but de notre travail a été d évaluer le suivi dermatologique et les tumeurs cutanées présentées par les patients qui ont reçu une greffe rénale au CHU de Grenoble et dont le greffon était fonctionnel depuis plus d un an. Dans notre cohorte de 436 patients, l incidence des verrues et des kératoses actiniques sont respectivement de 48,8% et 20,6%, et augmentent avec la durée d immunosuppression. L incidence des carcinomes cutanés est de 19,3%. Contrairement à la plupart des études de la littérature, notre population présente plus de carcinomes basocellulaires (123 au total) que de carcinomes épidermoïdes invasifs (49), et aucun cas de carcinome métastatique n a été recensé dans cette série. Les facteurs de risque des carcinomes cutanés confirment par contre ceux de la littérature : l âge élevé lors de la greffe, la durée d immunosuppression, le phototype clair, la présence de verrues et de kératoses actiniques. Les lésions virales, ainsi que les lésions précancéreuses et les carcinomes sont localisées principalement sur les zones photoexposées, laissant supposer un rôle important de l exposition solaire. Cependant cette prédominance sur les zones photoexposées est plus marquée pour les carcinomes épidermoïdes que pour les carcinomes basocellulaires et les maladies de Bowen. Malgré l incidence élevée des tumeurs cutanées dans notre série, il apparaît que le suivi dermatologique est insuffisant puisque moins de deux tiers des patients ont consulté un dermatologue depuis la greffe. L enseignement des règles de photoprotection et les contrôles dermatologiques devraient donc être intensifiés.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Suicidal hanging resulting in decapitation: A case report and review of the literature.

International audienceDecapitation following suicidal hanging is rarely encountered in forensic practice. The authors report a case of suicidal hanging resulting in decapitation following a fall of 5m. This case is compared with 30 cases found in the literature. Several factors including type of rope, skin abrasion, level of the severed vertebrae, thyroid cartilage and hyoid bone injuries and vital signs are studied. The force applied to the neck and the kinetic energy were calculated. The kinetic energy (ranging from 1820 to 7310J) takes into account the weight of the victim but also the length of the rope (height of the fall). The speed of the body as it is stopped by the rope ranged between 6.49 and 14.01ms-1

Suicidal hanging resulting in decapitation: A case report and review of the literature.

International audienceDecapitation following suicidal hanging is rarely encountered in forensic practice. The authors report a case of suicidal hanging resulting in decapitation following a fall of 5m. This case is compared with 30 cases found in the literature. Several factors including type of rope, skin abrasion, level of the severed vertebrae, thyroid cartilage and hyoid bone injuries and vital signs are studied. The force applied to the neck and the kinetic energy were calculated. The kinetic energy (ranging from 1820 to 7310J) takes into account the weight of the victim but also the length of the rope (height of the fall). The speed of the body as it is stopped by the rope ranged between 6.49 and 14.01ms-1

Methodology for estimating endocranial capacity in a modern European population

International audienceVarious methods have been published in the literature to estimate endocranial capacity. These are based on mathematical equations using measurements made directly on the skull or indirectly from X-rays, by filling the skull with various materials, by endocasts both physical and virtual (using 3D CT-scan reconstructions). Each method has its advantages, limits and drawbacks. A useful method is one that is simple, time-efficient, cheap, and reproducible. For this study we estimated endocranial capacity by filling the skull with calibrated glass beads. We used a thorough protocol of tamping to ensure results reproducibility. Intra- and inter-observer trials showed no significant differences. The method was applied to 130 recent French (West European) skulls (65 males and 65 females). Sexual dimorphism was studied using logistic regression functions, discriminant analysis, and neural network. The best results were obtained using the neural network, built with two hidden nodes in the hidden layer and one output node, and trained with a steepest descent algorithm. Our tests show that there is obvious sexual dimorphism (p < 10(-5)) of the weight of the skulls (623.44 ± 106.83 g in males; 548.07 ± 94.57 in females), the weight of the glass beads used to fill the skulls (2379.83 ± 228.92 g in males; 2095.95 ± 145.49 in females), and endocranial capacity (1676.47 cm(3) ± 161.26 in males; 1476.48 ± 102.49 in females), but overlapping between sexes is quite significant. The average ECC in male (1676.5 cm(3)) and in female (1476.5 cm(3)) subjects is higher than those previously published, which deserves some discussion

Methodology for estimating endocranial capacity in a modern European population

International audienceVarious methods have been published in the literature to estimate endocranial capacity. These are based on mathematical equations using measurements made directly on the skull or indirectly from X-rays, by filling the skull with various materials, by endocasts both physical and virtual (using 3D CT-scan reconstructions). Each method has its advantages, limits and drawbacks. A useful method is one that is simple, time-efficient, cheap, and reproducible. For this study we estimated endocranial capacity by filling the skull with calibrated glass beads. We used a thorough protocol of tamping to ensure results reproducibility. Intra- and inter-observer trials showed no significant differences. The method was applied to 130 recent French (West European) skulls (65 males and 65 females). Sexual dimorphism was studied using logistic regression functions, discriminant analysis, and neural network. The best results were obtained using the neural network, built with two hidden nodes in the hidden layer and one output node, and trained with a steepest descent algorithm. Our tests show that there is obvious sexual dimorphism (p < 10(-5)) of the weight of the skulls (623.44 ± 106.83 g in males; 548.07 ± 94.57 in females), the weight of the glass beads used to fill the skulls (2379.83 ± 228.92 g in males; 2095.95 ± 145.49 in females), and endocranial capacity (1676.47 cm(3) ± 161.26 in males; 1476.48 ± 102.49 in females), but overlapping between sexes is quite significant. The average ECC in male (1676.5 cm(3)) and in female (1476.5 cm(3)) subjects is higher than those previously published, which deserves some discussion

Etude de phase II de l’administration de Pembrolizumab en monothérapie et en première ligne chez des patients présentant un carcinome épidermoïde cutané inopérable.

International audienc

Pembrolizumab as first line therapy in patients with unresectable squamous cell carcinoma of the skin: Interim results of the phase 2 CARSKIN trial.

International audienc

Phase II Study of Pembrolizumab As First-Line, Single-Drug Therapy for Patients With Unresectable Cutaneous Squamous Cell Carcinomas

International audiencePURPOSE To evaluate first-line pembrolizumab monotherapy efficacy and safety in patients with unresectable cutaneous squamous cell carcinomas (CSCCs). PATIENTS AND METHODS Patients, predominantly men, with their CSSCs’ immunohistochemically determined programmed cell death-ligand 1 (PD-L1) status determined (tumor proportion score threshold, 1%), received pembrolizumab (200 mg every 3 weeks). The primary endpoint was the 39-patient primary cohort’s objective response rate at week 15 (ORR W15 ). Secondary objectives were best ORR, overall survival (OS), progression-free survival (PFS), duration of response (DOR), safety, ORR according to PD-L1 status and health-related quality of life using Functional Assessment of Cancer Therapy–General (FACT-G) score. An 18-patient expansion cohort, recruited to power the study to evaluate the ORR W15 difference between PD-L1+ and PD-L1– patients, was assessed for ORR, disease control rate, and safety, but not survival. RESULTS Median age of all patients was 79 years. The primary cohort’s ORR W15 was 41% (95% CI, 26% to 58%), including 13 partial and 3 complete responses. Best responses were 8 partial and 8 complete responses. At a median follow-up of 22.4 months, respective median PFS, DOR, and OS were 6.7 months, not reached, and 25.3 months, respectively. Pembrolizumab-related adverse events affected 71% of the patients, and 4 (7%) were grade ≥ 3. One death was related to rapid CSCC progression; another resulted from a fatal second aggressive head and neck squamous cell carcinoma diagnosed 15 weeks postinclusion. ORR W15 for the entire population was 42%; it was significantly higher for PD-L1+ patients (55%) versus PD-L1– patients (17%; P = .02). Responders’ W15 total FACT-G score had improved ( P = .025) compared with nonresponders. CONCLUSION First-line pembrolizumab monotherapy exhibited promising anti-CSCC activity, with durable responses and manageable safety. PD-L1 positivity appears to be predictive of pembrolizumab efficacy