Thomassin-Naggara I.,Tenon Medical |
Darai E.,Hopitaux Universitaires Paris Est |
Bazot M.,Tenon Medical
Diagnostic and Interventional Imaging | Year: 2012
The diagnosis of pelvic infection is most often made clinically, based on a combination of pelvic pain and fever, and possibly a foul discharge. The patient is referred to radiology in two very different circumstances: either in the acute phase where the challenge is to differentiate a pelvic infection from appendicitis, urinary tract infection, and complications of a hemorrhagic luteal cyst; or some time after the infectious episode, which may have gone unnoticed, and the patient presents with an undetermined pelvic mass that needs to be characterized, where the challenge in that situation is not to confuse it with ovarian cancer. The signs and symptoms on the pelvic ultrasound, CT scan, and MRI suggest the correct diagnosis. © 2012 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.
Sonigo C.,University Paris - Sud |
Dray G.,Interne |
Chabbert-Buffet N.,Hopitaux Universitaires Paris Est
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012
Menopause is a total follicular depletion leading to menstruation cessation. Climacterics symptoms are linked to estrogen decrease. Hormonal replacement therapy (HRT) was developed in 1940s in order to control these signs and to improve women's quality of life. In United States, conjugated equine estrogen, first estrogens developed, are the most common. In France, customs are different with the transdermic estrogen use. The progesterone use is also different between both countries: in USA, medroxyprogesteron acetate is the most common, whereas this treatment does not exist anymore in France. Indeed, lot of different progestagen is available in France: progesterone, dydrogesterone others progestin. Publication of randomized trials, as the Women's Health Initiative, had shown a long-term unfavorable HRT risk/benefit ratio, as prescribed in USA. These studies have led to prescription modification. Due to these results, recent trials, closers to French customs, allowed a new evaluation of HRT risk/benefit ratio. Today, clinical practices are based on these results and new trials are necessary. © 2012 Elsevier Masson SAS. All rights reserved.
Thomin A.,University Pierre and Marie Curie |
Friszer S.,Hopitaux Universitaires Paris Est |
Fajac A.,Reseau sein a risque |
Darai E,University Pierre and Marie Curie |
Chabbert-Buffet N.,University Pierre and Marie Curie
Annales d'endocrinologie | Year: 2014
Breast cancer prevention can be provided by using SERMs or aromatase inhibitors depending on the ovarian status, with a global risk reduction of 50 to 60%. Prophylactic annexectomy offered to reduce ovarian risk in BRCA mutation carriers also lowers breast cancer risk by 50%. Main side effects include deep vein thrombosis for SERMs, hot flushes and joint pain (although less frequently than initially suspected) with aromatase inhibitors. Other strategies based on progesterone, insulin or prolactin signaling modulation may be offered in the future. Criteria for candidate selection remain to be established. Copyright © 2014. Published by Elsevier Masson SAS.
Collura A.,French Institute of Health and Medical Research |
Collura A.,University Pierre and Marie Curie |
Lagrange A.,French Institute of Health and Medical Research |
Lagrange A.,University Pierre and Marie Curie |
And 64 more authors.
Gastroenterology | Year: 2014
Background & Aims Patients with colorectal tumors with microsatellite instability (MSI) have better prognoses than patients with tumors without MSI, but have a poor response to 5-fluorouracil-based chemotherapy. A dominant-negative form of heat shock protein (HSP)110 (HSP110DE9) expressed by cancer cells with MSI, via exon skipping caused by somatic deletions in the T17 intron repeat, sensitizes the cells to 5-fluorouracil and oxaliplatin. We investigated whether HSP110 T17 could be used to identify patients with colorectal cancer who would benefit from adjuvant chemotherapy with 5-fluorouracil and oxaliplatin. Methods We characterized the interaction between HSP110 and HSP110DE9 using surface plasmon resonance. By using polymerase chain reaction and fragment analysis, we examined how the size of somatic allelic deletions in HSP110 T17 affected the HSP110 protein expressed by tumor cells. We screened 329 consecutive patients with stage II-III colorectal tumors with MSI who underwent surgical resection at tertiary medical centers for HSP110 T17. Results HSP110 and HSP110DE9 interacted in a 1:1 ratio. Tumor cells with large deletions in T17 had increased ratios of HSP110DE9:HSP110, owing to the loss of expression of full-length HSP110. Deletions in HSP110 T17 were mostly biallelic in primary tumor samples with MSI. Patients with stage II-III cancer who received chemotherapy and had large HSP110 T17 deletions (≥5 bp; 18 of 77 patients, 23.4%) had longer times of relapse-free survival than patients with small or no deletions (≤4 bp; 59 of 77 patients, 76.6%) in multivariate analysis (hazard ratio, 0.16; 95% confidence interval, 0.012-0.8; P =.03). We found a significant interaction between chemotherapy and T17 deletion (P =.009). Conclusions About 25% of patients with stages II-III colorectal tumors with MSI have an excellent response to chemotherapy, due to large, biallelic deletions in the T17 intron repeat of HSP110 in tumor DNA. © 2014 by the AGA Institute.
Arana R.,Hopitaux Universitaires Paris Est |
Arana R.,University Pierre and Marie Curie |
Flejou J.-F.,Hopitaux Universitaires Paris Est |
Flejou J.-F.,University Pierre and Marie Curie |
And 3 more authors.
Colorectal Disease | Year: 2015
Aim: The clinicopathological and virological characteristics of anal superficially invasive squamous-cell carcinoma (SISCCA) were determined. Method: Seventeen patients with a completely excised stage T1N0M0 anal squamous-cell carcinoma (SCC) were included in the study. The tumours were divided into superficially invasive and invasive. Patients with anal high-grade squamous intraepithelial dysplasia, which corresponded to anal intraepithelial neoplasia (AIN) Grades 2 or 3, were used as a control group. Clinicopathological and virological characteristics were investigated. Overall survival and cancer recurrence-free survival were also assessed. Results: Of the 17 patients, 12 (70.5%) were men. Ten (58.8%) were human immunodeficiency virus positive. Seven (41%) patients met the same diagnostic criteria as those recently proposed for anal SISCCA. According to the results obtained using the polymerase chain reaction, human papillomavirus (HPV) 16 was the most commonly detected (94%) type of HPV. Twelve (70.6%) patients with an inadequate surgical margin around the tumour received adjuvant radiotherapy, including the two (11.7%) tumours that locally recurred, one of which was an anal SISCCA. Superficially invasive anal cancers differed from the other T1N0M0 anal carcinomas according to the clinical presentation and the absence of lymph-vascular invasion (LVI). There were no differences in cancer recurrence-free and overall survival rates between the superficially invasive and invasive groups. Conclusion: Anal SISCCAs have a low index of clinical suspicion, are associated with an absence of LVI and are linked to high-risk HPV. Prospective studies are needed to define the clinical behaviour of these anal tumours and to determine their best therapeutic strategy. © 2015 The Association of Coloproctology of Great Britain and Ireland.