Les nouveautés dans les formes héréditaires des cancers colorectaux

This review will be focused on the recent advances in the field of hereditary colorectal cancer syndromes. They are dominated by the identification of the new entity called « MYH-associated polyposis » and by significant advances in different aspects of Lynch syndrome: diagnosis, molecular basis, phenotypic-genotypic correlations, surveillance…     

Progrès dans les traitements des cancers du rein

Partial nephrectomy is the gold standard for the renal tumours less than 7 to 10 cm whenever feasible in order to preserve renal function. The extension of nephron-sparing surgery using a mini-invasive approach is possible by robotic surgery. Radical nephrectomy is mandatory in the other situations and especially in case of locally advanced renal carcinoma. The place of cytoreductive nephrectomy in metastatic renal cell carcinoma is the purpose of the CARMENA trial. Tyrosine kinase inhibitors are currently the first line treatment; but in the near future new immunotherapy by checkpoints molecules could crucially change the treatment of metastatic renal cell carcinoma. Numerous trials in a neoadjuvant or adjuvant settings are ongoing.     

Évaluation de la réponse histologique dans les cancers du rectum localement avancés après traitement néoadjuvant

Locally advanced rectal cancers mainly correspond to lieberkünhian adenocarcinomas and are defined by T3–T4 lesions with or without regional metastatic lymph nodes. Such tumors benefit from neoadjuvant treatment combining chemotherapy and radiotherapy, followed by surgery with total mesorectum excision. Such a strategy can decrease the rate of local relapses and lead to an easier complementary surgery. The pathologist plays an important role in the management of locally advanced rectal cancer. Indeed, he is involved in the gross examination of the mesorectum excision quality and in the exhaustive sampling of the most informative areas. He also has to perform a precise histopathological analysis, including the determination of the circumferential margin or clairance and the evaluation of tumor regression. Indeed this parameter is a major prognostic factor which has to be included in the pathology report. Moreover, the next challenge for the pathologist will be to determine and validate new prognostic and predictive markers, notably by using pre-therapeutic biopsies. The goal of this review is to emphasize the pathologist’s role in the assessment of histologic response of locally advanced rectal cancers after neoadjuvant treatment.     

Quelles sont les bonnes indications d’exérèse locale des petits cancers du rectum ?

Rectal resection with mesorectum excision is the standard operation for rectal tumors. Local surgery is an alternative with excellent operative results and no risk of functional troubles but with no lymph nodes staging. Then, unfavorable pathologic criteria must be assessed on local rectal specimen: depth of submucosal invasion (T1sm3), positive resection margins, vascular and/or lymphatic invasion. Further radical surgery is required in case of unfavorable criteria. Transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal tumors with high surgical excision quality (R0 resection), especially for mid and upper lesions, which are inaccessible by conventional local surgery.     

Résultats cliniques des modulateurs sélectifs du récepteur des estrogènes (SERM)

The SERMs (selective estrogen receptor modulators) are a new class of molecules that bind to the estrogen receptor, resulting in an estradiol agonist or antagonist response according to the target tissue. Raloxifene, a new SERM, has been shown to prevent postmenopausal bone loss, to reduce the risk of vertebral fractures in osteoporotic women, to decrease serum cholesterol and its LDL fraction, and to reduce significantly the risk of breat cancer. Raloxifene is available in France for the prevention of post-menopausal osteoporosis.     

Résultats de la réparation primaire des plaies du nerf médian et du nerf ulnaire au poignet

IntroductionWounds on the palmar side of the wrist affecting the median or ulnar nerves are responsible for motor and sensory sequelae, severe pain and cold intolerance.Materials and methodsThirty-nine patients with 40 nerve sections were retrospectively reviewed with a mean follow up of 23 months. The median nerve alone was affected 20 times, the ulnar nerve seven times and both nerves simultaneously 13 times. In 75% of the cases, there was an associated vascular injury (radial artery and/or ulnar artery). The average number of tendons cut was 4.25.ResultsAfter repair of the median nerve, 71% of patients recovered antepulsion and opposition that was normal or possible against resistance. The strength was approximately 70% of the opposite side. The sensitive recovery was good (S3 in ≥ 50% of cases) but it was accompanied by cold intolerance one out of two patients. After repair of the ulnar nerve, 29% of the cases had an ulnar claw hand, 71% of patients recovered sensitivity greater or equal to S3 but with cold intolerance in 42% of the cases. The combined median and ulnar sections had a poorer sensory-motor prognosis. Revision surgery was necessary in 12 of these cases.ConclusionSensory recovery after an isolated ulnar nerve lesion at the wrist is better than after an isolated median nerve lesion but there is no difference in the motor recovery. Combined median and ulnar lesions have an especially bad prognosis and may require secondary palliative surgery. The existence of nerve contusion and a high number of tendon injuries were factors associated with a poorer prognosis.     

Coagulation du faisceau spino-thalamique et du faisceau quinto-thalamique par stéréotaxie — Indications — Résultats

Résumé Notre impression actuellement est que la section des faisceaux spinothalamique ou quinto-thalamique au niveau du pédoncule cérébral, réalisable avec une gravité très réduite constitue l'intervention anti-algique idéale pour les algies d'origine périphérique intéressant une moitié du corps et en particulier pour les algies du membre supérieur et les algies craniofaciales. En ce qui concerne les douleurs centrales, par contre, nous devons actuellement encore formuler quelques réserves, quant à la possibilité d'action, malgré le cas isolé d'une névralgie zonateuse apparemment guérie par cette intervention et de deux algies continues faciales pouvant être presumées cliniquement comme appartenant au groupe des algies centrales.La durée de l'analgésie ainsi obtenue reste un point auquel nous ne pouvons pas répondre en raison du recul insuffisant dont nous disposons.

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Summary The authors describe a stereotactic method for the interruption of the spinothalamic and trigemino-thalamic tracts in the brain stem (midbrain) immediately before their entrance into the nucleus ventralis posterior of the thalamus. They are of the opinion that this is a safe and useful operation. They consider this the most suitable operation for unilateral pain either in the arm or in the face. They describe their good operative results.

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Zusammenfassung Die stereotaktische Ausschaltung des Tractus spino-thalamicus und des Tractus trigemino-thalamicus wird als empfehlenswerte Operation bei sonst therapieresistenten Schmerzen in einer Gesichtshälfte oder in einer oberen Extremität beschrieben. Gute Behandlungsresultate werden mitgeteilt.

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Resumen Descripción de un metodo estereotáxico para la interruptión de las vias espinotalámicas y trigémino-talámicas en el mesencéfalo inmediatamente antes de su entra da en el nucleo ventral posterior del tálamo. Consideran que éste método es mejor para casos de dolor unilateral en el territorio del brazo o de la cara y describen los buenos resultados operatorios obtenidos.

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Riassunto Gli AA. descrivono un metodo per 1'interruzione stereotattica del tratto spinotalamico e trigemino-talamico a livello del tronco cerebrale (mesencefalo), immediatamente prima dell'ingresso nel nucleo ventrale posteriore del talamo. Ritengono che questa operazione sia da raccomandarsi in quanto del tutto priva di rischio. L'intervento è indicato sopratutto nelle sindromi dolorose unilaterali a carico di una delle estremità superiori o della faccia. Vengono descritti ottimi risultati di trattamento.

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Communication du Congrès Européen de Zurich, Juillet 1959.