Leclere F. M., Schoofs M., Vogt P., Casoli V., Mordon S.   1950-nm diode laser-assisted microanastomoses (LAMA):an innovative surgical tool for hand surgery emergencies.  Lasers Med Sci.  2015 ;30 :1269-73

Based on previous observations, the 1950-nm diode laser seems to be an ideal wavelength for laser microvascular anastomoses. The data presented here, part of a larger ongoing study, assess its use in emergency hand surgery. Between 2011 and 2014, 11 patients were operated on for hand trauma with laser-assisted microanastomoses (LAMA) and prospectively analysed. LAMA was performed with a 1950-nm diode laser after placement of equidistant stitches. For vessel size <
1.5 mm, the following laser parameters were used:spot size 400 mum, five spots for each wall, power 125 mW, and arterial/venous fluence 100/90 J/cm(2) (spot duration 1/0.9 s). Mean operating time for arterial and venous microanastomoses was 7.3 +/- 1.4 and 8.7 +/- 1.0 min, respectively. Three anastomoses required a secondary laser application. Arterial and venous patency rates were 100 % at the time of surgery. The success rate for the 11 procedures assessed clinically and with the Doppler was 100 %. The technique is compared to the current literature. The 1950-nm LAMA is a reliable tool with excellent results in emergency hand surgery. The system is very compact and transportable for utilization in the emergency operating room.

Vignion-Dewalle A. S., Betrouni N., Tylcz J. B., Vermandel M., Mortier L., Mordon S.   Comparison of three light doses in the photodynamic treatment of actinic keratosis using mathematical modeling.  J Biomed Opt.  2015 ;20 :58001
Leroy H. A., Vermandel M., Lejeune J. P., Mordon S., Reyns N.   Fluorescence guided resection and glioblastoma in 2015:A review.  Lasers Surg Med.  2015 ;47 :441-51

High-grade gliomas represent a widely heterogeneous group of tumors, the most frequent of which is glioblastoma multiforme. Its annual incidence has risen over the last decades, particularly amongst elderly people. The actual standards of care allow for a 15-month median survival rate for WHO grade IV gliomas. As recurrence occurs in more than 85% of patients at the surgical margins, the initial resection extent is a cornerstone of disease control. Fluorescence guided resection (FGR) aims at increasing complete resections and, thus, local control. This technique uses 5-aminolevulinic acid (5-ALA), a natural intermediate substance in the heme-porphyrin biosynthesis pathway, and a protoporphyrin IX (PpIX) precursor. PpIX is fluorescent under blue light exposure. Recent studies reported a significant increase in complete resections using FGR, which were associated with prolonged progression free survival, fewer reinterventions, and delayed neurological deterioration. Here, we depict the principles of this surgical technique, its actual outcomes, and future developments. Lasers Surg. Med. 47:441-451, 2015. (c) 2015 Wiley Periodicals, Inc.

Beauval J., Roumiguié M., Gas J., Marcq G., Filleron T., Rischmann P., Villers A., Soulié M., Ouzzane A.   [Not Available].  Prog. Urol..  2015 ;25 :739-40
Aboukais R., Marinho P., Baroncini M., Bourgeois P., Leclerc X., Vinchon M., Lejeune J. P.   Ruptured cerebral arteriovenous malformations: Outcomes analysis after microsurgery.  Clin. Neurol. Neurosurg..  2015 ;138 :137-142

OBJECTIVE: Our study aimed to evaluate the functional outcome and the risk of postoperative remnant in patients with rAVM after microsurgical treatment. MATERIALS AND METHODS: This is a retrospective of 139 consecutive patients operated for a rAVM between 2002 and 2012 in our institution. The age at diagnosis and the WFNS score were recorded for each patient before treatment. All patients were re-evaluated 3 months after treatment using mRS scale. Conventional angiography was performed in the first 2 postoperative weeks and then a year later to detect any remnant or recurrence. RESULTS: The mean age at diagnosis was 30.8 years (range 4-69 SD: +/-5) and 44 patients had an age at diagnosis <18 yo. The mRS score 3 months after treatment was 2, SPM grade>2 and preoperative evaluation limited only to CT angiography in emergency situation (p<0.05). CONCLUSION: Functional outcome after microsurgical treatment was good in 83% of patients with rAVM. Good results were also recorded in 28% of patients with poor initial neurological status and severe intracerebral hemorrhage, which required immediate surgery. In case of remnant, a further treatment should be decided in a true multidisciplinary discussion to protect the patient from any rebleeding.

Dewalle-Vignion A. S., Betrouni N., Baillet C., Vermandel M.   Is STAPLE algorithm confident to assess segmentation methods in PET imaging?.  Phys. Med. Biol..  2015 ;60 :9473-9491

Accurate tumor segmentation in [18F]-fluorodeoxyglucose positron emission tomography is crucial for tumor response assessment and target volume definition in radiation therapy. Evaluation of segmentation methods from clinical data without ground truth is usually based on physicians' manual delineations. In this context, the simultaneous truth and performance level estimation (STAPLE) algorithm could be useful to manage the multi-observers variability. In this paper, we evaluated how this algorithm could accurately estimate the ground truth in PET imaging. Complete evaluation study using different criteria was performed on simulated data. The STAPLE algorithm was applied to manual and automatic segmentation results. A specific configuration of the implementation provided by the Computational Radiology Laboratory was used. Consensus obtained by the STAPLE algorithm from manual delineations appeared to be more accurate than manual delineations themselves (80% of overlap). An improvement of the accuracy was also observed when applying the STAPLE algorithm to automatic segmentations results. The STAPLE algorithm, with the configuration used in this paper, is more appropriate than manual delineations alone or automatic segmentations results alone to estimate the ground truth in PET imaging. Therefore, it might be preferred to assess the accuracy of tumor segmentation methods in PET imaging.

Borghesi Y., Narducci F., Bresson L., Tresch E., Meurant J. P., Cousin S., Cordoba A., Merlot B., Leblanc E.   Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery.  Ann. Surg. Oncol..  2015 ;22 :S936-S943

PURPOSE: In November 2010, the French National Cancer Institute published new guidelines for managing endometrial cancer. Pelvic lymphadenectomy is not indicated for preoperative low-intermediate risk type 1 endometrial cancer, and high-risk patients should undergo secondary surgery with para-aortic lymphadenectomy. This study evaluated these new guidelines with regard to overall survival (OS), relapse-free survival (RFS), and morbidity for patients with low-intermediate risk disease. METHODS: We evaluated all type 1 endometrial cancer patients with low-intermediate risk of recurrence who were treated from 1 January 1997 through 31 December 2012. All patients were classified according to the 2009 International Federation of Gynecology and Obstetrics staging criteria and the European Society for Medical Oncology. RESULTS: Overall, 230 patients were included (159 before and 71 after the new guidelines were issued). Pelvic lymphadenectomies were performed before and after the new guidelines in 77.4 and 28.6 % of patients, respectively (p < 0.001). After 2010, eight patients also underwent secondary surgery, which consisted of a para-aortic lymphadenectomy for lymphovascular space invasion (LVSI). This second surgery changed the adjuvant treatment for one patient. OS and RFS were similar between both groups, and no difference in morbidity was observed between the groups. LVSI was an independent factor for OS [hazard ratio (HR) 7.2, 95 % CI 3.1-17; p < 0.001] and RFS (HR 3.7, 95 % CI 1.6-8.5; p < 0.003). CONCLUSIONS: Fewer pelvic lymphadenectomies in low-intermediate risk patients did not affect OS, RFS, or morbidity, including patients with secondary surgery. We must gather additional data with a longer follow-up period to not only confirm our results but to also fully investigate the paradoxical absence of decreased morbidity that our study has shown.

Reix B., Flamand V., Bernhard J., Bigot P., Villers A.   [Not Available].  Prog. Urol..  2015 ;25 :826-7
Amici E. G., Battistella M., Beylot-Barry M., Chatellier A., Dalac-Ra S., Dreno B., Falandry C., Froget N., Giacchero D., Grob J. J., Guerreschir P., Leccia M. T., Malard O., Mortier L., Routier E., Stefan A., Stefan D., Stoebner P. E., Basset-Seguin N.   Defining and recognising locally advanced basal cell carcinoma.  Eur. J. Dermatol..  2015 ;25 :586-594

BACKGROUND: Rarely, basal cell carcinomas (BCCs) have the potential to become extensively invasive and destructive, a phenomenon that has led to the term "locally advanced BCC" (laBCC). We identified and described the diverse settings that could be considered "locally advanced". METHODS: The panel of experts included oncodermatologists, dermatological and maxillofacial surgeons, pathologists, radiotherapists and geriatricians. During a 1-day workshop session, an interactive flow/sequence of questions and inputs was debated. RESULTS: Discussion of nine cases permitted us to approach consensus concerning what constitutes laBCC. The expert panel retained three major components for the complete assessment of laBCC cases: factors of complexity related to the tumour itself, factors related to the operability and the technical procedure, and factors related to the patient. Competing risks of death should be precisely identified. To ensure homogeneous multidisciplinary team (MDT) decisions in different clinical settings, the panel aimed to develop a practical tool based on the three components. CONCLUSION: The grid presented is not a definitive tool, but rather, it is a method for analysing the complexity of laBCC.

Azais H., Queniat G., Bonner C., Kerdraon O., Tardivel M., Jetpisbayeva G., Frochot C., Betrouni N., Collinet P., Mordon S.   Fischer 344 Rat A Preclinical Model for Epithelial Ovarian Cancer Folate-Targeted Therapy.  Int. J. Gynecol. Cancer.  2015 ;25 :1194-1200

OBJECTIVE: Ovarian cancer prognosis remains dire after primary therapy. Recurrence rates are disappointingly high as 60% of women with advanced epithelial ovarian cancer considered in remission will develop recurrent disease within 5 years. Special attention to undetected peritoneal metastasis and residual tumorous cells during surgery is necessary as they are the main predictive factors of recurrences. Folate receptor alpha (FRalpha) shows promising prospects in targeting ovarian cancerous cells. Our aim was to determine if the Fischer model described by Rose et al could be used to evaluate folate-targeted therapies in preclinical studies. METHODS: NuTu-19 epithelial ovarian cancer cell line was used to induce peritoneal carcinomatosis in female Fischer 344 rats. FRalpha expression by NuTu-19 cells was assessed in vitro by immunofluorescence using "Cytospin(R)" protocol. In vitro folate-targeted compound uptake by NuTu-19 cells was evaluated by incubation of FRalpha-positive ovarian cancer cell lines (NuTu-19/SKOV-3/OVCAR-3/IGROV-1) with or without (control) a folate-targeted photosensitizer. Intracellular incorporation was assessed by confocal microscopy. Determination of in vivo FRalpha tissue expression by several organs of the peritoneal cavity was studied by immunohistochemistry. RESULTS: NuTu-19 cells express FRalpha which allows intracellular incorporation of folate-targeted compound by endocytosis. FRalpha is expressed in tumor tissue, ovary, and liver. Peritoneum, colon, small intestine, and kidney do not express the receptor. CONCLUSIONS: Female Fischer 344 rat is an inexpensive reproducible and efficient preclinical model to study ovarian peritoneal carcinomatosis folate-targeted therapies.