Le chordome de la colonne cervicale

Résumé Observation d'une femme de 37 ans, qui présente un volumineux chordome des vertèbres C. 4 et C. 5, évoluant depuis 3 ans.Du point de vue radiologique, il faut noter l'intégrité relative des corps vertébraux par rapport à la destruction massive des masses latérales d'un côté. L'angiographie vertébrale met en évidence un foyer de vascularisation pathologique non spécifique. L'importance du développement de la tumeur dans les tissus mous du cou et de la nuque, bien visible entre autres sur les clichés standards par le refoulement de la trachée, nous parait être un argument valable en faveur du chordome dans le diagnostic différentiel d'avec les autres tumeurs malignes des vertèbres.La radiosensibilité de la tumeur fut indiscutable dans notre cas. Il y a grand intérêt à profiter de la fonte de la masse tumorale par les radiations à hautes doses pour entreprendre ensuite l'exérèse chirurgicale aussi complète que possible.

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Summary The case is recorded of a female, aged 37, who presented with a massive Chordoma of C4 and C5 which had developed over three years.From the radiological point of view it should be noted that there was relative preservation of the vertebral bodies in association with extensive destruction of the lateral masses on one side. Vertebral angiography showed an area of non-specific pathological circulation. The significance of tumour growth in the soft tissues of the neck, which was well shown on the standard projections by compression of the trachea, seems to us to be a valid argument for including chordoma in the differential diagnosis of other malignent tumours of the vertebrae.In our case the tumour was undoubtedly radiosensitive. The melting away of the tumour mass by radiation therapy in high dosage is of considerable interest to the subsequent undertaking of surgical extirpation as completely as possible.

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Zusammenfassung Kasuistische Beschreibung einer 37jährigen Frau mit einem umfangreichen Chordom der Wirbel C 4 und C 5, das sich innerhalb von drei Jahren entwickelt hat. In radiologischer Hinsicht ist die relative Intaktheit der Wirbelkörper im Vergleich zur erheblichen Zerstörung der Massae laterales einer Seite zu erwähnen. Die Vertebralis-Angiographie läßt einen Herd mit unspezifischer pathologischer Vaskularisation erkennen. Die Entwicklung des Tumors in den Weichteilen des Halses und Nackens, die übrigens auf den Übersichtsaufnahmen durch die Verlagerung der Trachea gut erkennbar ist, scheint uns in differentialdiagnostischer Hinsicht ein wertvoller Hinweis auf ein Chordom zu sein und ermöglicht die Abgrenzung von anderen malignen Wirbeltumoren.In unserem Fall war der Tumor eindeutig radiosensibel. Es scheint nützlich zu sein, zunächst die Tumormassen durch hochdosierte Bestrahlung zu verkleinern und dann eine möglichst radikale chirurgische Entfernung anzuschließen.

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Resumen Observación de un caso de una mujer de 37 años, que presenta un cordoma voluminoso de las vertebras C 4 y C 5, con una evolución de 3 años.Desde el punto de vista radiológico hay que destacar la integridad relativa de los cuerpos vertebrales en relación con la destrucción masiva de las masas laterales de un lado. La angiografía vertebral puso de manifiesto un foco de vascularización patológica y no específica. La importancia del crecimiento del tumor en las partes blandas del cuello y de la nuca, que son visibles en las places por el gran rechazamiento de la traquea, nos parecen un argumento de peso en favor de un cordoma, en diagnóstico diferencial con otros tumores malignos vertebrales.En nuestro caso la radiosensibilidad del tumor fué indiscutible. Tiene un gran interés la disminución de la masa tumoral por la radiación a dosis elevada para completar el tratamiento con una exéresis lo más completa posible.

     

Temporal relationship between the decrease in arterial pressure and sodium retention in conscious spontaneously hypertensive rats with carbon tetrachloride-induced cirrhosis

It has been proposed that the initial event of sodium retention in cirrhosis is a peripheral arteriolar vasodilation causing underfilling of the arterial vascular compartment and stimulation of the renin-aldosterone and sympathetic nervous systems. To test this hypothesis, systolic blood pressure, sodium balance and urinary excretion of sodium and aldosterone were sequentially measured in 13 conscious spontaneously hypertensive rats submitted to a cirrhosis induction program with carbon tetrachloride and phenobarbital and in 14 control hypertensive animals. No significant differences were found between control and cirrhotic rats in any of the measured parameters during the first 7 wk of the study. The eighth week sodium retention developed in cirrhotic rats as indicated by a positive sodium balance and a marked decrease of sodium excretion. At the same time a significant reduction in systolic blood pressure and a great increase in urinary excretion of aldosterone were detected. These changes were more marked the ninth week of the study. In cirrhotic rats there was a highly significant direct correlation between systolic blood pressure and urinary sodium excretion. Postmortem examination showed a histological picture of cirrhosis in all animals given carbon tetrachloride and ascites in six of them. These results indicate that the onset of hyperaldosteronism and sodium retention in conscious spontaneously hypertensive rats with carbon tetrachloride-induced cirrhosis is chronologically related to a significant decrease in arterial pressure, thus supporting the "peripheral arterial vasodilation hypothesis" of ascites.     

Original removing technique of the kidneys for transplantation. An experimental study (author's transl)]

The depicted procedure minimizes the hazards of aggressive manipulations, and excludes any possibility of so-called "warm ischaemia". The kidneys are flushed out in situ with cool pulsatile perfusion through an aortic cannula. Kidneys, aorta and inferior vena cava are then removed en-bloc without interrupting the perfusion, and preserved in Collins' solution at 4 degrees C. After a 6 to 19 hour storage time, one of the kidneys is transplanted on another dog, while the second one is submitted to histological examination. Nine transplantations were carried out, followed in 7 cases with a most satisfactory diuresis resuming, and with urinary ionic levels, as well as daily urea output, normalization within 48 hours. Histologic examination showed an unaffected glomerular apparatus, but some mild tubular lesions.     

Essai d'information sur les drogues en milieu scolaire genevois

Summary This compulsory information is given to students of 12 th grade (14 – 15 years). A film is shown which is followed by a discussion between the students of each class and a doctor of the Health Department who is specialized in drug prevention.Teachers and parents are also informed in the same way.The efficiency of this method will have to be proved in the future.

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Unterrichtsversuch über Drogen in Sekundarschulen in Genf

Zusammenfassung Dieser obligatorische Unterricht findet für Schüler vom 12. Schuljahr (14 – 15 Jahre alt) statt.Ein Film und eine nachfolgende Diskussion zwischen Schülern und Spezialistärzten der Jugend-und Gesundheitsabteilung sind dafür gebraucht werden. Die Lehrer der Sekundarschulen und die Eltern sind gleichfalls unterrichtet.Die Wirksamkeit dieser Präventiverziehung wird noch zu bestimmen sein.

     

Severe obstetric complications nescessitating hospitalization and intensive care: a ten year retrospective study

OBJECTIVES: To assess the serious maternal morbidity during pregnancy, delivery and post partum, which led to an hospitalization in a medical or surgical intensive care unit. STUDY DESIGN: A Retrospective study was carried out on a period of ten years, from July 1986 to July 1996, in the University Teaching Hospital of Besan?on. PATIENTS: The criterions of inclusion come from the definition of the serious maternal morbidity decided by the Inserm: any admission of a pregnant woman in a medical or surgical intensive care unit in the 42 days of the post-partum, whatever the term of the pregnancy and the type of the post-partum, extra uterine pregnancy, spontaneous miscarriage and medical or voluntary abortion. METHODS: Forty-six patient's medical file hospitalized in a medical or surgical intensive care unit between July, 1st 1986 and July, 31st 1996, have been studied. RESULTS: The analysis of the cause underline the gravity of the pathologies handled with young patients and initially healthy, the short length of controlled ventilation and hospitalization, the avoidability of great number of transfer in an intensive care unit, and the lack of hospitalization due to anaesthesia. The frequency of hospitalisation in an intensive care unit during and after the pregnancy was estimated at 0.17% of lives births. CONCLUSION: The serious maternal morbidity could be an indicator of the quality of the obstetrics cares which would complete the study of the maternal mortality. The potential gravity of the complication of the pregnancy and the delivery require better care of this patients.     

Investigation of the in vitro and ex vivo acetylcholinesterase and antioxidant activities of traditionally used Lycopodium species from South America on alkaloid extracts

Ethnopharmacological relevance

The study was aimed at evaluating medicinal and therapeutic potentials of two Lycopodiaceae species, Lycopodium clavatum (L.) and Lycopodium thyoides (Humb. & Bonpl. ex Willd), both used in South American folk medicine for central nervous system conditions. Alkaloid extracts were evaluated for chemical characterization, acetylcholinesterase and antioxidant activities.

Materials and methods

The alkaloid extracts obtained by alkaline extraction were determined for each species by GC/MS examination. The evaluation of the anticholinesterase and the antioxidant activities of the extracts were tested by determining in vitro and ex vivo models. Effects on acetylcholinesterase (AChE) were tested in vitro using rat brain homogenates and ex vivo after a single administration (25, 10 and 1 mg/kg i.p.) of the alkaloid extracts in mice. The in vitro antioxidant effects were tested for the 2-deoxyribose degradation, nitric oxide (NO) interaction, 2,2-diphenyl-1-picryl hydrazyl (DPPH) radical scavenging activity and total reactive antioxidant potential (TRAP). After an acute administration (25 and 10 mg/kg i.p.) of the extracts in middle-aged (12 months) mice, the antioxidant effects were estimated through the thiobarbituric acid reactive substances test (TBARS), and the antioxidant enzymes activities for catalase (CAT) and superoxide dismutase (SOD) were measured.

Results

AChE activity was inhibited in vitro by the alkaloid-enriched extracts of both Lycopodium species in a dose and time-dependent manner in rat cortex, striatum and hippocampus. A significant inhibition was also observed in areas of the brain after acute administration of extracts, as well as decreased lipid peroxidation and increased CAT activity in the cortex, hippocampus and cerebellum. A moderate antioxidant activity was observed in vitro for the extracts. Chemically, the main alkaloids found for the two species were lycopodine and acetyldihidrolycopodine.

Conclusion

This study showed that the biological properties of the folk medicinal plants Lycopodium clavatum and Lycopodium thyoides include AChE inhibitory activity and antioxidant effects, two possible mechanisms of action in Alzheimer's related processes.     

Enhancing the Buccal Mucosal Delivery of Peptide and Protein Therapeutics

Pharmaceutical Research - With continuing advances in biotechnology and genetic engineering, there has been a dramatic increase in the availability of new biomacromolecules, such as peptides and...     

HPV circulating tumor DNA to monitor the efficacy of anti‐PD‐1 therapy in metastatic squamous cell carcinoma of the anal canal: A case report

Squamous cell carcinoma of the anal canal (SCCA) is a rare HPV‐associated cancer with limited sensitivity to standard chemotherapy. In a phase 2 study, nivolumab, an anti PD‐1 immune checkpoint inhibitor, demonstrated significant efficacy as single‐agent therapy in metastatic SCCA patients. Nevertheless, imaging assessment by standard RECIST criteria of the efficacy of immune therapy can be difficult in some patients due to tumor immune cell infiltration, and biomarkers of treatment efficacy are needed. We have previously developed a quantitative droplet digital PCR (ddPCR) technique to detect HPV circulating tumor DNA (HPV ctDNA), with excellent sensitivity and specificity. Here, we report, for the first time, the kinetics of HPV ctDNA during therapy in a patient with metastatic SCCA, who obtained sustained partial response to single‐agent nivolumab. We observed an early and very significant decrease of HPV ctDNA during therapy from the baseline level of 3713 copies/ml plasma to 564 copies/ml plasma at 4 weeks, and 156 copies/ml at 6 weeks, followed by a plateau. This observation provides proof‐of‐concept that HPV ctDNA can be used as a noninvasive early dynamic biomarker to monitor the efficacy of new immunotherapy agents.     

Anti-inflammatory effects of hydroalcoholic extract and two biflavonoids from Garcinia gardneriana leaves in mouse paw oedema

Garcinia gardneriana (Planch. & Triana) Zappi (Clusiaceae) is widely distributed in Brazil and used in folk medicine to treat inflammation, pain, and urinary tract and other infections. However, very few studies have analyzed these therapeutic effects. In this study, the anti-inflammatory effects of the hydroalcoholic extracts from Garcinia gardneriana (HEGG) and some of its isolated biflavonoids were evaluated. The results showed that HEGG from the leaves, bark and seeds reduced carrageenan-induced mouse paw inflammation, in addition to diminishing the myeloperoxidase activity in the stimulated tissues. The reduction of neutrophil infiltration by treatment with the HEGG from leaves was confirmed by histology. The leaf extract also reduced the paw oedema evoked by bradykinin, histamine, prostaglandin E2 and 12-O-tetradecanoylphorbol acetate. However, it partially decreased substance P and compound 48/80-caused paw oedema, without any influence on the arachidonic acid-induced oedema. Both of the isolated compounds, fukugetin and GB-2a, prevented the carrageenan-induced paw oedema. In conclusion, this study showed important anti-inflammatory effects of HEGG through its interaction with different intracellular signaling pathways, without interfering with the formation of arachidonic acid (AA) metabolites. These characteristics, in addition to the wide distribution and culturing ease of the plant, confirm its popular use and highlight its promise in the development of new anti-inflammatory drugs.