Single and combined impacts of irradiation and surgery on lymphatic vasculature and fibrosis associated to secondary lymphedema

Lymphedema (LD) refers to a condition of lymphatic dysfunction associated with excessive fluid accumulation, fibroadipose tissue deposition and swelling. In industrialized countries, LD development mainly results from a local disruption of the lymphatic network by an infection or cancer-related surgery (secondary LD). In the absence of efficient therapy, animal models are needed to decipher the cellular and molecular mechanisms underlying LD and test putative drugs. In this study, we optimized and characterized a murine model of LD that combines an irradiation of the mice hind limb and a radical surgery (lymph node resection associated to lymphatic vessel ligation). We investigated the respective roles of irradiation and surgery in LD formation by comparing their impacts, alone or in combination (with different intervention sequences), on eight different features of the pathology: swelling (paw thickness), indocyanine green (ICG) clearance, lymphatic vasculature remodeling, epidermal and dermal thickening, adipocyte accumulation, inflammatory cell infiltration and collagen deposition. This study supports the importance of radiation prior to surgery to experimentally induce a rapid, severe and sustained tissue remodeling harboring the different hallmarks of LD. We provide the first experimental evidence for an excessive deposition of periostin (POSTN) and tenascin-C (TNC) in LD. Through a computerized method of digital image quantification, we established the spatial map of lymphatic expansion, as well as collagen, POSTN and TNC deposition in papillary and reticular dermis of lymphedematous skins. This mouse model is available to study the patho-physiology of LD and test potential therapeutic targets.

[Rhinophyma, management methods and oncological risk]

Rhinophyma is the most advanced stage of rosacea (stage IV). It is a benign lesion but aesthetically disabling. We present through a major case of rhinophyma and a review of the literature the diagnostic modalities, the therapeutic alternatives and the risks to be known. Particularly, we detail the risks of oncologic transformation of these poorly known lesions.The management of these rare lesions is based on a collaboration between the surgeon and the dermatologist.

[Isolated superior ophthalmic vein thrombosis due to tamoxifen]

Superior ophthalmic vein thrombosis is a rare entity, which may lead to serious vision complications. We report the unusual observation of a 78-year-old patient who developed exophtalmos, chemosis, and blurred vision due to isolated superior ophthalmic vein thrombosis. This rare complication is likely due to tamoxifen therapy. In contrast with published data, in the present case, cessation of tamoxifen therapy did not improve ocular symptoms.

Progress report on immunotherapy of chronic myeloid leukemia

A total of 88 better risk patients and 47 poor-risk patients with chronic myeloid leukemia have received repeated vaccinations with BCG or BCG-cultured cell mixtures at our institutions. The number of viable BCG organisms injected appeared to be the most important parameter of immunologic stimulation in this study. Excessive doses of BCG were associated with a significant incidence of disabling complications and with no survival benefit. Better risk patients receiving lower doses of BCG had suggestive prolongation of survival (p less than 0.1). Immunotherapy had little effect on the course of poor-risk patients but evaluation of this heterogeneous population is difficult; additional studies would be desirable among patients in whom reversal of poor prognostic signs can be achieved.