Morphinothérapie intra-thécale dans les douleurs cancéreuses (l'expérience brestoise de janvier 1991 à avril 2011)

Les douleurs réfractaires sont au coeur de la problématique actuelle en cancérologie, et leur prise en charge reléve d'une coordination des soins, avec le recours a des techniques plus invasives, comme la morphinothérapie intrathécale. L'efficacité a été démontrée au travers d une étude rétrospective menée au CHU de Brest sur 18 patients. Se pose la question d une typologie des patients, afn de mieux cerner le passage à la réfractorité des douleurs cancéreuses, dans un souci d anticipation d une telle indication thérapeutique. A trop vouloir soulager le symptôme douloureux, la médecine scientifique risque de faire l'impasse sur la souffrance globale du patient.BREST-BU Médecine-Odontologie (290192102) / SudocSudocFranceF

Horseradish peroxidase retrograde labeling of primary sensory neurons: A comparison of four intraspinal applicaton methods

International audienc

[Anterior lumbar interbody fusion for treatment of failed back surgery syndrome: a retrospective study of 46 cases]

International audienc

Retrospective study of 19 patients with intramedullary spinal cord metastasis

International audienc

Venous organization in the transverse foramen: dissection, histology, and magnetic resonance imaging.

International audienceThe anatomical arrangement of the venous system within the transverse foramen is controversial; there is disagreement whether the anatomy consists of a single vertebral vein or a confluence of venous plexus. Precise knowledge of this arrangement is necessary in imaging when vertebral artery dissection is suspected, as well as in surgical approaches for the cervical spine. This study aimed to better explain anatomical organization of the venous system within the transverse foramen according to the Trolard hypothesis of a transverse vertebral sinus. This was an anatomical and radiological study. For the anatomical study, 10 specimens were analyzed after vascular injection. After dissection, histological cuts were prepared. For the radiological study, a high-resolution MRI study with 2D time-of-flight segment MR venography sequences was performed on 10 healthy volunteers. Vertebral veins are arranged in a plexiform manner within the transverse canal. This arrangement begins at the upper part of the transverse canal before the vertebral vein turns into a single vein along with the vertebral artery running from the transverse foramen of the C-6. This venous system runs somewhat ventrolaterally to the vertebral artery. In most cases, this arrangement is symmetrical and facilitates radiological readings. The anastomoses between vertebral veins and ventral longitudinal veins are uniform and arranged segmentally at each vertebra. These findings confirm recent or previous anatomical descriptions and invalidate others. It is hard to come up with a common description of the arrangement of vertebral veins. The authors suggest providing clinicians as well as anatomists with a well-detailed description of components essential to the understanding of this organization

Régénération des axones sensitifs primaires et pontages radicello- médullaires (étude expérimentale après traumatisme médullaire chez le rat adulte)

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients

International audienceBACKGROUND:To assess the influence of the time interval between surgical resection and standard combined chemoradiotherapy on survival in newly diagnosed and homogeneously treated (surgical resection plus standard combined chemoradiotherapy) glioblastoma patients; while controlling confounding factors (extent of resection, carmustine wafer implantation, functional status, neurological deficit, and postoperative complications).METHODS:From 2005 to 2011, 692 adult patients (434 men; mean of 57.5 ± 10.8 years) with a newly diagnosed glioblastoma were enrolled in this retrospective multicentric study. All patients were treated by surgical resection (65.5% total/subtotal resection, 34.5% partial resection; 36.7% carmustine wafer implantation) followed by standard combined chemoradiotherapy (radiotherapy at a median dose of 60 Gy, with daily concomitant and adjuvant temozolomide). Time interval to standard combined chemoradiotherapy was analyzed as a continuous variable and as a dichotomized variable using median and quartiles thresholds. Multivariate analyses using Cox modeling were conducted.RESULTS:The median progression-free survival was 10.3 months (95% CI, 10.0-11.0). The median overall survival was 19.7 months (95% CI, 18.5-21.0). The median time to initiation of combined chemoradiotherapy was 1.5 months (25% quartile, 1.0; 75% quartile, 2.2; range, 0.1-9.0). On univariate and multivariate analyses, OS and PFS were not significantly influenced by time intervals to adjuvant treatments. On multivariate analysis, female gender, total/subtotal resection and RTOG-RPA classes 3 and 4 were significant independent predictors of improved OS.CONCLUSIONS:Delaying standard combined chemoradiotherapy following surgical resection of newly diagnosed glioblastoma in adult patients does not impact survival