Transforming the landscape of colorectal cancer treatment with immunotherapy: Evolution and future horizons

Colorectal cancer (CRC) continues to be one of the most prevalent and lethal cancers worldwide. Over the past decades, immune checkpoint inhibitors (ICIs) have shown to significantly improve patient outcomes in mismatch repair-deficient metastasized CRC. However, widening the scope of this novel treatment modality has been the object of growing interest. This article will review several landmark trials, while exploring various aspects of this rapidly evolving field, including potential neoadjuvant (or even entirely nonsurgical) and adjuvant indications in localized disease. We will also discuss differences between management of rectal and colon cancer, current and expected challenges (eg. resistance, toxicities, pseudoprogression, biomarkers) and other future opportunities including combinations with other therapeutic agents and the role of ICIs in the treatment of both deficient as well as proficient mismatch repair (dMMR and pMMR respectively) CRC.

Quality of pathology reporting and adherence to guidelines in rectal neuroendocrine neoplasms: a Belgian national study

The incidence of neuroendocrine neoplasms (NEN) in the rectum is rising since the introduction of colonoscopy screening programs. Guidelines, such as the European NeuroEndocrine Tumor Society (ENETS) algorithm, are mainly based on expert opinion. The goal of this nationwide study is to gain a better insight into the evolution in pathology reporting and adherence to the ENETS guidelines in Belgium. In Belgium, all NENs have to be reported to the Belgian Cancer Registry. We thoroughly reviewed all available pathology reports, coded as rectal NEN between 2004 and 2015, and reclassified according to World Health Organisation (WHO) classification 2019. To evaluate the adherence to the ENETS guidelines, population-based cancer registry data were linked with the medical procedures of the Belgian Health Insurance database. A total of 670 rectal NEN were retained and 16% of the cases needed reclassification. Annual incidence between 2004 and 2015 tripled from 0,20 to 0,61 per 100.000 inhabitants. Reporting of Ki67 proliferation index ameliorated most, while reporting of tumor size, lymphovascular and perineural invasion remained disappointing. Endoscopic ultrasound was performed in only 36.6% of the cases, while the mostly recommended mode of treatment (endoscopic/surgical/no resection) was followed in the majority of the cases. Incidence of rectal NEN in Belgium increased throughout the years and quality of pathology reporting improved especially after the WHO classification update in 2010. The growing awareness and knowledge among clinicians and pathologists in the community counters the need for centralization.

Molecular detection of Helicobacter pylori and clarithromycin resistance in gastric biopsies: a prospective evaluation of RIDA®GENE Helicobacter pylori assay

Background: Empirical treatment of Helicobacter pylori (HP) depends on the local prevalence of clarithromycin resistance but data are lacking and culturing of HP is time-consuming. We evaluated RIDA®GENE Helicobacter pylori assay (r-biopharm), a quantitative PCR assay for detecting HP and clarithromycin resistance mutations in gastric biopsies.Material/methods: Gastric biopsies were obtained from each of 436 consecutive patients referred for gastroscopic investigation and results of qPCR were compared to culture and immunohistochemical staining (IHCS).Results: Of 436 samples, 47 were positive for HP by PCR (11%), 42 by culture (9.7%) and 44 by IHCS (10%). Compared to culture, sensitivity and specificity of the qPCR were 100% and 99%, respectively, and 96% and 99% compared to IHCS. The sensitivity and specificity for clarithromycin resistance detection were 92% and 97%, respectively.Conclusions: RIDA®GENE Helicobacter pylori assay reliably and rapidly detects HP and its resistance to clarithromycin in human gastric biopsies.

Accuracy of whole-body diffusion-weighted MRI (WB-DWI/MRI) in diagnosis, staging and follow-up of gastric cancer, in comparison to CT: a pilot study

Background

Accurate staging of patients with gastric cancer is necessary for selection of the most appropriate and personalized therapy. Computed tomography (CT) is currently used as primary staging tool, being widely available with a relatively high accuracy for the detection of parenchymal metastases, but with low sensitivity for the detection of peritoneal metastases. Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) has a very high contrast resolution, suggesting a higher diagnostic performance in the detection of small peritoneal lesions. The aim of this study was to retrospectively evaluate the added value of whole-body diffusion-weighted MRI (WB-DWI/MRI) to CT for detection of peritoneal carcinomatosis (PC) and distant metastases in the preoperative staging of gastric cancer.

Methods

This retrospective study included thirty-two patients with a suspicion of gastric cancer/recurrence, who underwent WB-DWI/MRI at 1.5 T, in addition to CT of thorax and abdomen. Images were evaluated by two experienced abdominal radiologists in consensus. Histopathology, laparoscopy and/or 1-year follow-up were used as reference standard.

Results

For overall tumour detection (n = 32), CT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 83.3%, 100%, 100% and 82.4% respectively. For WB-DWI/MRI these values were 100%, 92.9%, 94.7% and 100%, respectively. For staging (n = 18) malignant lymph nodes and metastases, CT had a sensitivity, specificity/PPV/NPV of 50%/100%/100%/71.4%, and 15.4%/100%/100%/31.3% respectively. For WB-DWI/MRI, all values were 100%, for both malignant lymph nodes and metastases. WB-DWI/MRI was significantly better than CT in detecting tumour infiltration of the mesenteric root, serosal involvement of the small bowel and peritoneal metastases for which WB-DWI/MRI was correct in 100% of these cases, CT 0%.

Conclusions

WB-DWI/MRI is highly accurate for diagnosis, staging and follow-up of patients with suspected gastric cancer.

Current practice in approaching controversial diagnostic and therapeutic topics in gastroenteropancreatic neuroendocrine neoplasm management. Belgian multidisciplinary expert discussion based on a modified Delphi method

BACKGROUND AND STUDY AIMS

Neuroendocrine neoplasms (NENs) are relatively rare, with marked clinical and biological heterogeneity. Consequently, many controversial areas remain in diagnosis and optimal treatment stratification for NEN patients. We wanted to describe current clinical practice regarding controversial NEN topics and stimulate critical thinking and mutual learning among a Belgian multidisciplinary expert panel.

PATIENTS AND METHODS

A 3-round, Delphi method based project, coordinated by a steering committee (SC), was applied to a predefined multidisciplinary NEN expert panel studying the following controversial topics : factors guiding therapeutic decision making, the use of somatostatin analogues (SSA) in adjuvant setting, the interference between non-radioactive and radioactive SSAs, challenging small intestine neuroendocrine tumor (NET) cases, the approach of the carcinoid syndrome, the role of chemotherapy in well differentiated NET, the relevance of NET G3 and neuroendocrine carcinoma subclassification and the role of imaging techniques in NEN management.

RESULTS

A high level of consensus exists regarding the necessary diagnostic work-up, use of imaging techniques and interference between non-radioactive and radioactive SSAs. However, the prognostic impact of tumor functionality might be overrated and adequate diarrhea differential diagnostic work-up in these patients is underused. Significant differences are seen between individual experts and centers regarding treatment preferences both on the treatment modality level, as well as the choice of specific drugs (e.g. chemotherapy regimen).

CONCLUSIONS

A Delphi-like multi-round expert discussion proves useful to boost critical thinking and discussion among experts of different background, as well as to describe current clinical practice and stimulate mutual learning in the absence of high-level scientific guidance.

Lanreotide in the prevention and management of high-output ileostomy after colorectal cancer surgery

Objective: Patients with stage III and high-risk stage II colorectal cancer (CRC) are advised to initiate adjuvant treatment as soon as feasible and certainly before 8 to 12 weeks after resection of the tumor. A protective ileostomy is often constructed during surgery to protect a primary anastomosis “at risk”, especially in rectal cancer surgery. However, up to 17% of patients with a stoma suffer from high output, a major complication that can prevent adjuvant treatment implementation or completion. To avoid delay or cancellation of adjuvant therapy after CRC resection, effective strategies must be implemented to successfully treat and/or prevent high-output stoma (HOS).

Methods: We report two clinical case reports clearly demonstrating the impact and management of HOS in this setting. A review of the available literature and ongoing clinical studies is provided.

Results: The clinical cases describe patients with advanced stage CRC and focus on the different strategies for HOS management, presenting their outcome and how each strategy affects the implementation of adjuvant treatment. The patient population with the highest risk of developing HOS is described, along with the rationale for using somatostatin analogs, such as lanreotide, to treat and prevent high output.

Conclusion: In patients with CRC and protective ileostomies after primary resection, HOS could be treated with somatostatin analogs in combination with dietary recommendations and Saint Mark's solution. The role of this therapeutic approach as a preventive strategy in patients at high risk of developing HOS, deserves further exploration in a prospective randomized clinical trial.

[French plastic surgeons: update in 2007]

French medical demography is a true public health issue. The medicine doctor's scarcity announced by many will not appear for the plastic surgeons. In this speciality, problems are an excess staff and irregular sharing out. The aim of the study was to make a very sharp update of the speciality thanks to an actual demographic descriptive and analytic study compared with the one realised in 1998 including a French plastic surgeon's activity study. In 2007, there were 889 plastic surgeons in France, so 235 surgeons more than in 1998 and an average of 26 new plastic surgeons a year. The plastic surgeon's density was 1 for 71,174 people, much more important than the recommended value. The distribution of these surgeons is still unequal and the excess staff is getting worse. The plastic surgeon's activity study based on the Information System Medicalisation Program (ISMP) between 2004 and 2006, including 13 classic plastic surgery's procedures, showed an important decrease of the activity especially for the private sector. The analytic study put together the data concerning the demography and the activity considering the economic side of esthetic surgery. Thanks to these data, plastic surgeons will now be able to choose their working area not only based on geographic reasons but also depending on the activity they want and on the importance of the competition. This work stands for a help for plastic surgeons, in the hope of a fair sharing out of these practioners.

The antiproliferative effect of somatostatin analogs: clinical relevance in patients with neuroendocrine gastro-entero-pancreatic tumours

Somatostatin analogs (SSAs) have an important role in the management of patients with neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP NETs). These compounds can control the symptoms induced by the production of hormones and peptides. The antiproliferative effects of SSAs and especially tumour shrinkage are less obvious in patients with GEP NETs than in those with acromegaly. However, based upon phase II experience there is a strong suggestion of a disease stabilizing effect of SSAs in selected patients. Those patients with a progressive, non-functional GEP NET, positive octreotide scintigraphy, a low proliferation index and in the absence of surgical options may benefit from a first-line medical therapy with SSAs. The exploration of the mechanisms of this effect are unclear and hampered by the lack of suitable preclinical models. The better understanding of the tumour biology of GEP NETs, together with the development of new SSAs with better affinity on all somatostatin receptors, represent an unmet medical need.

«Greffe de visage»: regards portés sur la première allotransplantation composite partielle de la face

The first facial allograft was realised in Amiens 2005 November 27th. Breaking the technical limits of the so called possible and in appearance transgressing some cultural forbidden in organ transplantation, this resolutely innovative intervention open more than new perspective in the surgery of the reconstruction after disfigurement, but also a wide field of scientific investigations about dynamic and meaning of the facial function. Obviously, it also deals with numerous ethical and medical problems. The authors here shortly described the technical points of the surgery firstly done to restore oral function and facial expressively, the principles of the immunosuppressive treatment built to control any rejection time episode and the anatomical, neurological and functional results obtained after more than 18 months follow-up. Those perfectly demonstrate the perfect morphological, dynamic and cortical integration of the graft in the recomposed face. They also allow to confirm the legitimacy of the surgical indication and to oppose the factual objective arguments to the ethical reticences dealing with the facial and psychological identity of the receptor.

Characterising error-awareness of attentional lapses and inhibitory control failures in patients with traumatic brain injury

Awareness deficits are a significant problem following traumatic brain injury (TBI). This study examined error processing as candidate marker of awareness and compared the performance of 18 TBI participants and 18 controls using an online error-monitoring task while participants performed simple go/no-go tasks. Error-monitoring performance was compared where the no-go target was part of (a) a predictive sequence, (b) predictive sequence plus a dual-task element and (c) a random sequence. Results showed that the TBI participants, in contrast to control participants, were significantly impaired at monitoring their errors during both predictive sequence tasks but were not impaired on the random sequence task. These findings suggest that following TBI, when an error is more impulsive it may be more easily monitored, whereas when an error is characterised by attentional drift, subsequent error-processing mechanisms may fail to engage. Higher levels of online error-awareness were also associated with lower levels of anxiety, fewer symptoms of frontal dysfunction and greater competence in everyday functioning.

[Modified Texier mediodorsal transposition island skin flap of the nose. Report of four cases of ala nasi reconstruction]

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.

Apport de l'imagerie tridimensionnelle à la chirurgie d'augmentation mammaire

The medical application of the interferometry is valid now. The breast surgery works on the shape and the volume of the tissue. The Inspeck technology is now available and works well in our medical practice. The measurement tools for the lengths, euclidian or projected on surface are working well with the same precision of a manual measurement. The estimation of the volume needs to follow exactly the same procedure to get some good results. The virtual breast modification doesn't work anymore with a scientific precision and does not allowed yet an office use. A development of the software is necessary to use all these data enclosed in the 3D models.

Apport de l'imagerie 3D à la chirurgie mammaire : étude préliminaire

Due to the development of the invasive technique of digital exam, the three-dimensional results are more and more precise, spectacular and helpful. The 3D surfacic model is for a medical approach and non invasive. Early in 2003, we have started a patient evaluation before and after surgery. The most common surgical techniques from the breast reconstruction to the breast augmentation and the lipomodeling have been analyzed. This preliminary study has shown objectively some surgical rules and volumetric results. Those results are the elements of the future development of the 3D surfacic model in plastic surgery.

Early emotional disturbances during nicotine patch therapy in subjects with and without a history of depression

BACKGROUND

The goal of this study was to compare development of emotional symptomatology during smoking cessation with transdermal nicotine patches in subjects with and without a history of depression.

METHODS

Twenty-five subjects, 14 with a history of depression and 11 without such a history, were evaluated before beginning of cessation, on day 8, day 30, day 90 and day 120.

RESULTS AND DISCUSSION

On day 120, ten subjects have maintained abstinence: 71.4% of subjects with and 45.5% of subjects without a history of depression relapsed. Both groups presented variable emotional symptomatology and there was no significant differences between subjects with and without a past depression. On the other hand, none of the symptoms which emerged during cessation predicted the issue of cessation. However, some symptoms appearing before beginning of cessation were related to subsequent relapse: lack of pleasure seeking and tiredness. Subsequent relapsers also tended to be more tense on baseline. These early symptoms can not be considered as withdrawal symptoms, they may reflect less confidence in success. It is also suggested that development of anhedonia represents an adaptative strategy to prepare for the withdrawal suffering.

[Psychological aspects of emotional regulation in smoking dependency]

We reviewed the literature on the relationships between smoking and affect regulation. There is strong evidence that vulnerability to smoking dependence is a function of a high initial sensitivity to nicotine, which produces reinforcing consequences that lead to chronic use. These strong reinforcers of tobacco dependence include regulation of mood and modulation of arousal. We focused on studies concerned with the subjective component of arousal and emotional experience. We discuss first the models and classifications used to differentiate types of smoking as related to the management of emotions and studies evaluating the stimulant and subjective effects of smoking behavior, questioning the paradoxical tranquilizing and anxiety-reducing effects of nicotine. We also looked into the mood regulation effects that may explain the strong relationships observed between depression and smoking and finally focus on some of the personality risk factors that may make individuals more susceptible to these rewarding properties of smoking.

Relationships between sensation seeking and emotional symptomatology during smoking cessation with nicotine patch therapy

This study explored relationships between the sensation-seeking trait and the development of emotional symptomatology during smoking cessation with nicotine transdermal patches. Twenty-five subjects were evaluated before they stopped smoking, on Day 8, Day 30, Day 90, and Day 120. Initial motives for smoking and the sensation-seeking personality trait were tested as possible predictors for the development of specific mood disturbances. Our subjects scored very high on sensation seeking, consistent with previous results on smokers. This may also be due to the well-known tendency of high sensation-seekers to be willing to try new experiences. The sensation-seeking trait did not predict the issue of cessation. However, it was related to emotional deficit (anhedonia, affective blunting), tiredness, and a lack of energy, before and during smoking cessation. Two different interpretations of emotional deficit are proposed.

Differential cognitive effects of colloid cysts in the third ventricle that spare or compromise the fornix

A series of twelve cases, all of whom had received surgery for the removal of a colloid cyst in the third ventricle, was examined on a series of memory tests. The only consistent predictor of poor memory performance that could be detected from MRIs was the presence of bilateral interruption of the fornix, which occurred in three of the subjects. Although these three cases were poor on tests of learning and recall, there was evidence that recognition was less impaired. The subjects were also tested on a set of recognition and concurrent discriminations that closely matched tests given to non-human primates. Clear parallels were found between the apparent effects of fornix damage in these clinical cases and those observed following more selective surgery in non-human primates. These findings not only indicate that fornix damage is sufficient to induce anterograde amnesia but also support the validity of recent animal tests that are thought to capture aspects of episodic memory.

[Cystic mesothelioma of the peritoneum in a male]

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.

Whipple's disease: benefit of the fine-needle aspiration cytology from lymph nodes

We report a case of Whipple's disease with predominant neurological symptoms and without any clinical digestive sign. The diagnosis was suspected by fine-needle aspiration from an axillary lymph node and confirmed by the duodenal biopsy and ultrastructural results. Whipple's disease is a rare, chronic, systemic infectious disease. Electron microscopy and PCR on paraffin blocks are very helpful when histologic findings are not discriminant. On cytologic examination, the major differential diagnosis is mycobacterial adenitis. Here we highlight the possibility of diagnosis Whipple's disease on mere cytological material.

[Isolated vasculitis of the spermatic cord]

The authors report a case of isolated spermatic cord vasculitis associated with testicular infarct in a 75-year-old man. No clinical symptoms or serological markers of a systemic disease were found. This is a rare disease which cannot be diagnosed without histological examination and which requires follow-up because of a risk of progression to autoimmune disease.

[Sensation seeking and anhedonia in risk taking. Study of a population of bungy jumpers]

This study presents the investigation of the relations between sensation seeking (41) and anhedonia in 80 subjects who practice a risk taking sport, bengy jump. These relations were examined according to different variables which characterize the practice of bengy jump: the total number of previous jumps and the motivations to jump (1. personal motivation, 2. professional motivation--working in the jumping organization, and 3. group motivation--for example being leaded to jump by friends). We also assessed the use of psychoactive substances. All jumpers (men and women) have higher scores than control subjects in Thrill and adventure seeking dimension. In men, the more the subjects score on this dimension, the less they score on the physical anhedonia scale (8). In women, Experience Seeking and Boredom Susceptibility dimensions are positively correlated with physical anhedonia and with the number of jumps. Moreover, women with personal motivation are those who score the highest on Thrill and Adventure Seeking and Boredom Susceptibility dimensions. These results suggest that in women, sensation seeking through bengy jumping may be linked to a boredom tendency and driven by a need to compensate for a difficulty in experiencing emotions and sensations from common and mundane stimuli. In men, high frequency of bengy jumping was negatively related to the use of psychoactive substances, suggesting that bengy jump, in a compulsive form recalling an addictive behavior, is a specific and preferential way of stimulation seeking.

Sensation-seeking and emotional disturbances in depression: relationships and evolution

The French abbreviated form of the sensation-seeking scale was given to 183 hospitalized depressed subjects meeting the DSM-III-R criteria for major depression. Depressed subjects, men and women, scored significantly lower than controls from the general population, paired as to age and sex, on all of the subscales. There was no relationship to the intensity of depression and anxiety. Relationships between emotional disturbances and sensation-seeking were differentiated according to the specificity of each subscale and to age and sex. There was no significant difference between baseline and after-treatment sensation-seeking scores and subjects at discharge still scored significantly lower than controls. Hypotheses on evolution at a later date after the hospitalization are made. The finding of positive relationships for some subjects between sensation-seeking and anhedonia is interpreted in regard to a compensatory process.

Sensation seeking, nicotine dependence, and smoking motivation in female and male smokers

Sensation-seeking scores in female (n = 36) and male (n = 60) French smokers were compared with those for a control group of female (n = 23) and male (n = 45) nonsmokers. The findings clearly show that smokers of both sexes are higher in sensation seeking than their nonsmoking counterparts: they score higher on the Disinhibition, Experience Seeking, and Boredom Susceptibility components of sensation seeking. Smoking women were particularly high on Experience Seeking. The relationships among the sensation-seeking components, nicotine dependence, and motives for smoking were assessed in the smokers. Disinhibition and Experience Seeking moderately correlated with nicotine dependence in females, as assessed by the Fagerström questionnaire and the Addictive factor of the Russell Classification of Smoking by Motives. Women high in Experience Seeking may be at particular risk for smoking and possibly for dependence. Further research is needed to state that the high sensation seeker is a person who might be expected to be particularly sensitive to the stimulating reward of smoking, and thus particularly vulnerable to becoming a dependent smoker.

Nicotine dependence and motives for smoking in depression

Smoking variables were assessed in female (n = 48) and male (n = 28) French hospitalized depressed smokers. Nicotine dependence, motives for smoking, and emotional situations in which depressed smokers were likely to smoke were compared with those of female (n = 36) and male (n = 60) nondepressed smokers from the general population. Depressed smokers scored higher than controls on nicotine dependence, and on stimulant and sedative smoking; they also reported that they were more likely to smoke in negative emotional situations. Sedative smoking decreased significantly between admission and discharge. Sedative smoking is a strong reason for smoking among depressed smokers regardless of degree of dependence, whereas stimulant smoking is positively correlated with degree of dependence. Nicotine dependence is also significantly correlated with anhedonia, and its relationship to depression is discussed in regard to nicotine action on hedonic systems.

[Sensation seeking and mood dimensions in depressive states]

This study presents the investigation of the relations between dimensions of depressive mood and sensations seeking in 55 hospitalized depressed subjects. The concept of sensation seeking, identified by M. Zuckerman as a personality dimension, has been defined as the need for the subject to reach his optimal level of activation. The four subscores of sensation seeking, relatively independent, are identified in the sensation seeking scale; they stand at different levels on the dimensions of activation and pleasure which are emotional dimensions. These emotional dimensions are investigated in the exploration of the emotional components of depressive mood; the different symptomatic regroupings, such as blunted affect or impulsivity, do not have the same relations with these dimensions. The sensation seeking concept appears fruitful to investigate the different troubles of affective dynamic, which stand on the expressive and behavioral level, and on the subjective level. As in several studies with normal populations, we find again the same inverse relation between age and sensation seeking, and men obtain higher scores on the Thrill and Adventure seeking factor and on the Desinhibition factor. Globally, depressed subjects have lower scores of sensation seeking than normal subjects (paired by age and sex); but the weakness of sensation seeking is not proportional to the intensity of depression (Hamilton Depressive Scale) and to the the intensity of anxiety (Covi Brief Anxiety Scale). Interesting relations appear with the depressive mood factors, which agree with previous studies of sensation seeking in psychology and psychopathology.(ABSTRACT TRUNCATED AT 250 WORDS)

Parallel Visual Information Processing Test. An experimental assessment of alexithymia

A novel clinical and experimental situation has been created, based on the psychopathological concepts of 'pensée opératoire' and alexithymia and the contribution of recent trends in cognitive science as to the dual skills of the brain hemispheres: the Parallel Visual Information Processing Test. This test was validated in more than 100 subjects, and revealed that holistic visual attention is reduced during logical task performance; this impairment appeared to be typical of patients with poor fantasizing ability and operative behavior. Such findings are consistent with some authors' theory according to which there is a functional commissurotomy in alexithymic and psychosomatic patients.

[French translation and validation of Izard's differential emotion scale. Study of the verbal qualification of emotions]

This work presents the validation of a French version of the emotional self rating scale by Izard (Differential Emotion Scale). This scale is based on the theory of the Discrete Emotions which proposes the existence of ten fundamental emotions. This self-rating scale consists of thirty emotional adjectives (three for each emotion). The validation was done by using a non inductive method (by asking the subject to describe his present emotional state) with 84 control subjects. It shows that this version is valid. Main results are first the binarisation of the emotions (positive and negative), then the existence of complex factors with psychopathological meaning after factorial analysis. These results are in agreement with a theory of expressive emotional levels more than with the theory of discrete emotions in psychopathology.

Splenosis: ultrasound and CT findings in a case complicated by an intraperitoneal implant traumatic hematoma

A case of intraperitoneal splenosis, found incidentally at ultrasound examination in a 35-year-old man, is reported. The diagnosis, suspected on the basis of computed tomographic (CT) and radionuclide studies, was established by surgery. Three years later, after direct trauma, ultrasound and CT studies revealed a surgically proven splenosis implant hematoma. The contribution of radiologic examinations in the diagnosis of splenosis is emphasized.