Lymphome oculo-cérébral : étude rétrospective de 56 cas au CHU de Caen de janvier 2011 à septembre 2019, point de vue ophtalmologique

Introduction: primary Lymphoma of the Central Nervous System (PCNSL) is located in the brain, spinal cord, meninges and eyes. The form located in the eye is also called primary vitreoretinal lymphoma. PCNSL is a rare cancer that accounts for 1% of lymphomas in France, and its ophthalmological involvement is exceptional. The main objective of this study is to analyse the characteristics of the patients cohort included in the LOC network in Caen. Material and method: retrospective study, including patients from the LOC network of the Caen University Hospital (PCNSL networks) from January 1, 2011 to September 30, 2019. Patients with an impairment outside the central nervous system were excluded. The characteristics analysed are clinical, paraclinical, as well as their initial treatment, overall survival and survival without recurrence. A comparison was made between patients with and without ocular impairment. Results: 56 patients were included. The median age was 66 years. The clinical signs most present were focal neurological signs. 20% of patients had vitreous haze. 80% of patients received systemic methotrexate chemotherapy. 11% of patients had an ocular relapse. Median follow-up was 32 months. The median progression-free survival was 18 months. The median overall survival was 29.7 months. Conclusion: in our study, patients without ocular damage were more likely to have a single lesion on MRI. There were no other significant differences between patients with and without ocular damage.Introduction : le Lymphome oculo-cérébral (LOC) est situé au niveau de l’encéphale, de la moelle-épinière, des méninges et des yeux. La forme localisée au niveau oculaire est également appelée lymphome vitréo-rétinien primitif. Le LOC est un cancer rare qui représente 1% des lymphomes en France, et son atteinte ophtalmologique est exceptionnelle. L'objectif principal de cette étude est d’analyser les caractéristiques de la cohorte de patients inclus dans le réseau LOC à Caen. Matériel et méthode : étude rétrospective, incluant les patients du réseaux LOC du CHU de Caen du 01 janvier 2011 au 30 septembre 2019. Les patients présentant une atteinte en dehors du système nerveux central étaient exclus. Les caractéristiques analysées sont cliniques, paracliniques, ainsi que leur traitement initial, leur survie globale et leur survie sans récidive. Une comparaison a été réalisée entre les patients avec ou sans atteinte oculaire. Résultats : 56 patients ont été inclus. L’âge médian était de 66 ans. Les signes cliniques les plus présents étaient les signes neurologiques focaux. 20% des patients présentaient un Tyndall vitréen. 80% des patients ont bénéficié d’une chimiothérapie systémique par méthotrexate. 11% des patients avaient une rechute au niveau oculaire. Le suivi médian était de 32 mois. La médiane de survie sans progression était de 18 mois. La médiane de survie globale était de 29,7 mois. Conclusion : dans notre étude les patients ne présentant pas d’atteinte oculaire avaient plus fréquemment une lésion unique à l’IRM. Il n’y avait pas d’autre différence significative entre les patients avec ou sans atteinte oculaire

Prospective Assessment of Early Proton Therapy-Induced Optic Neuropathy in Patients With Intracranial, Orbital or Sinonasal Tumors: Impact of A Standardized Ophthalmological Follow Up

CERVOXY CLINInternational audiencePurpose Proton therapy (PT) can be a good option to achieve tumor control while reducing the probability of radiation induced toxicities compared to X-ray-based radiotherapy. However, there are still uncertainties about the effects of PT on the organs in direct contact with the irradiated volume. The aim of this prospective series was to report 6-month follow-up of clinical and functional optic neuropathy rates of patients treated by proton therapy using a standardized comprehensive optic examination. Methods and Materials Standardized ophthalmological examinations were performed to analyze subclinical anomalies in a systematic way before treatment and 6 months after the end of proton therapy with: Automatic visual field, Visual evoked potential (VEP) and optic coherence of tomography (OCT). Results From October 2018 to July 2020 we analyzed 81 eyes. No significant differences were found in the analysis of the clinical examination of visual functions by the radiation oncologist. However, considering VEP, the impairment was statistically significant for both fibers explored at 30’angle (p:0.007) and 60’angle (p <0.001). In patients with toxicity, the distance of the target volume from the optical pathways was more important with a p-value for 30’VEP at 0.035 and for 60’VEP at 0.039. Conclusions These results confirm uncertainties concerning relative biological effectiveness of proton therapy, linear energy transfer appears to be more inhomogeneous especially in areas close to the target volumes. The follow-up of patients after proton therapy is not an easy process to set up but it is necessary to improve our knowledges about the biological effects of proton therapy in real life. Our study which will continue during the coming years, suggests that follow-up with in-depth examinations such as VEP as a biomarker could improve the detection of early abnormalities

Epicardial and Pericardial Adiposity Without Myocardial Steatosis in Cushing Syndrome

International audienceAbstract Context Cardiovascular disease is the leading cause of death in patients with Cushing syndrome. Cortisol excess and adverse metabolic profile could increase cardiac fat, which can subsequently impair cardiac structure and function. Objective We aimed to evaluate cardiac fat mass and distribution in patients with Cushing syndrome. Methods In this prospective, cross-sectional study, 23 patients with Cushing syndrome and 27 control individuals of comparable age, sex, and body mass index were investigated by cardiac magnetic resonance imaging and proton spectroscopy. Patients were explored before and after biochemical disease remission. Myocardial fat measured by the Dixon method was the main outcome measure. The intramyocardial triglyceride/water ratio measured by spectroscopy and epicardial and pericardial fat volumes were secondary outcome measures. Results No difference was found between patients and controls in intramyocardial lipid content. Epicardial fat mass was increased in patients compared to controls (30.8 g/m2 [20.4-34.8] vs 17.2 g/m2 [13.1-23.5], P < .001). Similarly, pericardial fat mass was increased in patients compared to controls (28.3 g/m2 [17.9-38.0] vs 11.4 g/m2 [7.5-19.4], P = .003). Sex, glycated hemoglobin A1c, and the presence of hypercortisolism were independent determinants of epicardial fat. Pericardial fat was associated with sex, impaired glucose homeostasis and left ventricular wall thickness. Disease remission decreased epicardial fat mass without affecting pericardial fat. Conclusion Intramyocardial fat stores are not increased in patients with Cushing syndrome, despite highly prevalent metabolic syndrome, suggesting increased cortisol-mediated lipid consumption. Cushing syndrome is associated with marked accumulation of epicardial and pericardial fat. Epicardial adiposity may exert paracrine proinflammatory effects promoting cardiomyopathy

Response to Letter to the Editor from Soghomonian: “Epicardial and Pericardial Adiposity Without Myocardial Steatosis in Cushing Syndrome”

International audienc

Exotismes

L’exotisme ou le goût pour ce qui vient d’ailleurs se constate au travers de l’introduction volontaire, rare, précoce ou banalisée d’éléments étrangers de toute nature (animaux, végétaux, minerais, produits de consommation alimentaires et manufacturés, formes, techniques architecturales, motifs décoratifs, matériaux…). Ces introductions sont-elles plutôt le fait des élites ? Lesquelles sont-elles devenues de véritables phénomènes de mode