Cancer de la prostate : utilité de la TEP-TDM à la F-fluorocholine

In oncology, positron emission computed tomography (PET/CT) has become an essential tool for initial staging, response evaluation and follow-up of cancer patients. Most of the frequent tumors (lung, breast, esophagus, and lymphomas) are highly avid for ¹⁸F-fluorodeoxyglucose (¹⁸FDG), but prostate cancer has not demonstrated significant uptake of FDG. The development of new tracers labeled with ¹⁸F such as choline analogs allowed already to obtain interesting results particularly in patients with biological relapse and inconclusive conventional imaging work-up. The impact of ¹⁸F-flurocholine PET/CT on patient management needs to be validated in large studies, but many centers use already this examination in order to guide further management, including radiotherapy planning.     

Pathologies de la prostate : actualités en médecine nucléaire (diagnostic et thérapeutique)

Nuclear medicine could significantly contribute to management of patients with prostate carcinoma. Apart from bone scintigraphy, and success of sentinel lymph node procedure, from a diagnosis point of view ¹⁸F-fluorocholine, which is now disposable, will certainly allow better staging accuracy, better efficiency of recurrences detection, and better treatments evaluation. Regarding to treatments, several radiopharmaceuticals demonstrated their efficiency as palliative treatment of painful bone metastasis, and maybe in the near future will contribute to curative treatment when associated to chemotherapy.     

Plaidoyer pour un outillage lithique de l’Âge du fer : le cas des maillets à gorge de l’Ouest de la France

The attention is turned here to one kind of tools, characterized by a special morphology: the grooved hammer-stones. They are known in Europe and all over the world in various cultures, as Neolithic or Bronze Age remains and generally linked to extraction or mining activity; but, the discovery of several of these tools in western France, within pre-roman archaeological contexts, especially in sites devoted to marine salt production, leads us to a discussion on dating and the function of such tools, and feeds a more general reflexion about the existence of a specialised lithic set of tools during the Iron Age.     

Autres applications de la MIBG : « applications de la scintigraphie de l’innervation myocardique à la 123-I-MIBG en neurologie »

Myocardial 123-I-metaiodobenzylguanidine (MIBG) imaging enables the assessment of postganglionic sympathetic cardiac innervation. Recently myocardial 123-I-MIBG scintigraphy has been found to be useful to distinguishing Parkinsońs disease (PD) from other akinetic rigid syndromes. The absence of published guidelines for cardiac 123-I-MIBG imaging makes standardization of procedures among individual users of this technique even more important. Cardiac MIBG study showed markedly decreased uptake in PD, dementia with Lewy bodies (DLB) and pure autonomic failure, which is a common feature of Lewy body disease. The cardiac MIBG uptake is severely impaired even in the early disease stage. Atypical parkinsonian syndromes, including Multiple System Atrophy, Progressive Supranuclear Palsy, and other, show modest reduction of cardiac MIBG uptake. The MIBG study can be used for differentiating patients with extrapyramidal signs and dementia, and might provide useful diagnostic information to discriminate DLB and Alzheime?s disease.     

Métastase rénale d’un carcinome vésiculaire de la thyroïde révélée par le balayage du corps entier à l’iode 131

Distant metastasis of differentiated thyroid carcinoma generally affect lung and/or bone tissue. Renal metastasis from thyroid carcinoma is extremely rare. We report a case of renal metastasis from a follicular thyroid carcinoma in a 55-year-old man, occuring 11 years after total thyroidectomy, fortuitously discovered on a whole body scan carried out after 131-iodine therapy for neck recurrence of disease. Salient features of our clinical case are the fortuitous mode of discovery the unilateral localization of metastases and especially the long time interval which separates its detection from that of the primitive tumour. This case report exemplifies the useful role of the whole body scan carried out after 131-iodine therapy better adapted to reveal often undetectable occult metastases with low dose, but also to ensure a regular and protracted follow-up of patients treated for differentiated thyroid carcinoma.     

La stratigraphie et le Paléolithique du complexe saalien dans la région de la Saale et de l’Elbe

Some sediment sequences were known in the Elbe-Saale region. They enable a subdivision of the Saale complex, that is from Neumark Nord (Geisel valley), from Weimar-Ehringsdorf and Bad Kösen-Lengefeld (Saale valley). According to it, there are two interglacials between the Saalian groundmoraine (s.str.) and the Eemian. They are characterized by a strong subcontinental climatic influence, which could not be observed in the other interglacials of the Elbe-Saale region. The interglacials are connected with find horizons from the Middle Palaeolithic. They are concisely described here with their inventories.     

Cancer de la prostate : les marqueurs biologiques

Normal prostate cells and prostate cancer cells produce prostate-specific antigen (PSA): thus, it is frequently increased in non-malignant conditions such as prostatitis and benign prostatic hyperplasia. Indeed, PSA is an excellent biomarker to monitor disease progression. The low diagnostic specificity of PSA leads to many false-positive and a large number of biopsies. These well-recognized limitations of PSA suggest that new prostate cancer biomarkers could play a useful role in reducing the number of unnecessary biopsies.     

Étude de faisabilité du ganglion sentinelle dans le cancer de la prostate par cœlioscopie : premiers résultats

Objectives

The standard lymphadenectomy is currently a challenge in the management of prostate cancer. The aim of this prospective study was to evaluate the performance of the sentinel lymph node (SLN) by laparoscopy in patients with localized prostate cancer, candidates for local treatment.

Patients and methods

Patients were injected transrectal ultrasound-guided with 0.3 mL/100MBq 99^mTc-Sulfur rhenium colloid in each prostatic lobe, the day before surgery. Lymphoscintigraphy was performed after 2 hours. The detection was realized intraoperatively with a laparoscopic probe (Gamma Sup Clerad^®) followed by extensive dissection. Counts of SLN were performed in vivo and confirmed ex vivo. The histological analysis was performed by HPS staining and followed by immunochemistry if SLN was free.

Results

Seventy patients with carcinoma of the prostate at intermediate or high risk of lymph node metastases (D’Amico), PSA median 9.5 ng/mL [6–130], were included in the study. The lymphoscintigraphic detection rate was 94.2% (66/70) and intraoperative of 97.0% (68/70). Fourteen patients had lymph node metastases, six only in SLN. The false negative rate was 2/14 (14.0%). The internal iliac region is the first metastatic site (40.9%). Limited or standard lymph node dissection would have ignored respectively 72.7% and 59.0% of lymph node metastases.

Conclusion

The laparoscopy is adapted to a broad identification of SLN and targeted dissection of these lymph nodes significantly limits the risk of surgical extended dissection while maintaining the accuracy of the information.     

Apport de l’imagerie hybride TEMP-TDM dans le suivi d’un cancer différencié de la thyroïde

In the management of patients with differentiated thyroid cancer (DTC), abnormalities detected on planar whole body scan and ¹³¹I-SPECT are difficult to interpret because of a lack of anatomical landmarks and limited specificity. Integrated ¹³¹I-SPECT-CT imaging has an additional value for characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization. We illustrate through an observation the incremental diagnostic value of ¹³¹I-SPECT-CT images in the diagnosis of a cervical lymph node mimicking a physiological uptake on planar views. A 35-year-old Tunisian female was followed for papillary thyroid carcinoma, for which she underwent total thyroidectomy and iratherapy. Three years after a complete remission, the thyroglobulin (Tg) level on TSH stimulation increased. Diagnostic planar images with ¹³¹I did not disclose any obvious pathological foci. Furthermore, we noticed an increased ¹³¹I-uptake in the left sub-mandibulary area, which suggested a salivary physiological activity. SPECT-CT of the neck and chest were then performed with a Symbia T camera. Fused images demonstrate that this activity corresponds to a cervical lymph node closely adjacent to sub-mandibulary gland. Management of the patient was then changed. In selected patients with DTC, hybrid imaging should be used as a complementary to planar imaging in terms of diagnostic accuracy, because of superior focus localization and additional anatomic information derived from the CT component. Integrated SPECT-CT is then a useful tool, especially in cases of unclear diagnoses, precising anatomical localization of areas of increased ¹³¹I-uptake and distinguishing malignant lesions from normal physiological uptakes. This is particularly important in an oncologic center, as ours, where we don’t yet have a positron emission tomography (PET) camera is not yet available.     

Fixations extra-osseuses du Tc MDP dans le cas d’un cancer du sein métastatique à l’os

Aim

To report and discuss an unusual visceral uptake on bone scan in a case of breast cancer with bone metastases.

Patient and methods

A 40-year-old woman, with untreated bilateral breast cancer was referred to our department for a bone scan.

Results

The bone scan evidenced multiple metastases over the axial skeleton. Uncommonly, visceral uptake was noted associating diffuse bilateral lung uptake and intense myocardium, stomach and kidneys uptakes. Serum calcium level was high: 4.08 mmol/L (normal: 2.38–2.70 mmol/L).

Conclusion

The incidental observation of metastasic calcifications on bone scan is often related to severe hypercalcemia. Such pattern should alert the physician on the existence and the severity of calcium metabolism disturbances that had not been suggested before.     

Synthèse des données archéologiques récentes sur le peuplement à l’Holocène de la réserve de faune de la Lopé, Gabon

This article summarizes the results of archaeological research led from 1995 to 1998 in the fauna reserve of Lopé (Gabon). The excavated sites were dated from the Upper Pleistocene to the Post-colonial period. It is the longest and the most complete archaeological sequence presently known in Central Africa. These results show evidence of human presence in the reserve for over 40?000 years and that this greatly contributed to the preservation of the ecotone landscape of Lopé. In addition, these results offer the first systematic analysis of the sites and the ceramic artefacts produced and used in the centre of Gabon during the last three millennia. Supported by chronological, linguistic and palaeoenvironmental data, these results allow us to refine the ceramic typology and to prove the antiquity of husbandry, agricultural practices and iron production in this part of Africa. Finally, they allow us to clarify the various phases of settlement in the reserve and to reveal an important historic phenomena in connection with the expansion of the bantu languages and/or the bantu speaking peoples, who populate a third of the African continent.     

Évaluation de la réponse au traitement des lymphomes : rôle de la TEP-FDG

Positron emission tomography (PET) with FDG has a prominent role in the staging of lymphoma, including Hodgkin's lymphoma and aggressive non Hodgkin's lymphoma. Its value in the assessment of end therapy response is also well established, especially with residual masses on CT scan to differentiate between fibrosis (scar) and active tissue. International experts with the International Harmonization Project of lymphoma have proposed a set of interpretation criteria. Finally, FDG-PET looks very promising in the early response assessment; it has shown to be predictive of chemosensitivity and of therapy response. Interpretation criteria have been improved and proposed. FDG-PET usefulness is being evaluated in national and international research protocols where therapeutic strategies are based on FDG-PET results.     

L’industrie aurignacienne de la grotte de Šandalja II (Istrie, Croatie) dans le contexte de la région de l’Est de l’Adriatique

This paper presents the results obtained by lithic analysis of Early Upper Palaeolithic levels in Šandalja II Cave, Istria, Croatia. Technological and typological analysis of stone and typological analysis of bone artefacts have been carried out. Production of flakes in Aurignacian levels (G, F, E and E/F) is dominant, but blade and bladelets production is also present. Blades and bladelets were produced by direct soft hammer technique. Aurignacian people of Šandalja II produced their debitage mainly on local grey chert, which is often patinated. Šandalja II is one of the rare—if not the only—site with Aurignacian industry in eastern Adriatic region. The main reason for absence of such industry at other sites can be seen in scarce population or abandonment of some parts of this region.     

L’étude des conditions d’habitabilité des établissements préhistoriques : à propos des amas coquilliers mésolithiques de la région cantabrique occidentale (Nord de l’Espagne)

We show the methodology we followed in order to reliably estimate a factor that, to our judgement, is fundamental for the assessment of the characteristics of a prehistoric settlement: the conditions of exposure to the sun. This methodology is applied to the study of Mesolithic shell middens in the North of Spain, with the aim to introduce a new kind of information in the debate about the meaning of shell middens. Throughout this century, different ways to understand the behaviour these remains conceal have been proposed. Our thesis with regard to it, presented in this paper, is based on the observation of a series of variables, among which we can find the exposure to the sun the settlements undergo. We therefore show in the last part of the paper, how to join the information from the proposed analysis with the other data subsequent from the study of other variables such as the environmental conditions prevailing during the period of formation of the sites; the situation of the settlements; the location of the remains in the caves; the entity of the occupations; and the energy spent on the transportation of the aquatic resources from the coast towards the places where their rests are found nowadays. In short, we propound a methodology for the study of one of the variables that falls upon the habitability of a prehistoric settlement and we point out the contribution that the incorporation of an analysis of this kind means for the research of Mesolithic shell middens in the North of Spain.     

Valeur pronostique de la TEP au F-FDG dans le bilan d’extension initial du cancer de l’œsophage traité par radiochimiothérapie exclusive

The aim of this retrospective study was to investigate the prognostic significance of initial FDG-PET in patients with newly diagnosed oesophageal carcinoma before exclusive radiochemotherapy. FDG-PET was performed in 29 patients with newly diagnosed oesophageal carcinoma before radiochemotherapy. Maximum standardized uptake value (SUV_max) was determined in each primary lesion and the presence of one or more PET-positive lymph nodes was recorded. Primary tumour volume and tumour length were assessed using two different thresholds for tumour delimitation: SUV = 2.5 and SUV = 40% of SUV_max. Patients were followed clinically during at least 1 year after initial FDG-PET. The median follow-up was 35 months (IC 95% = 26-41 months). Thirteen patients (45%) died during the follow-up. By univariate logistic regression analysis, the SUV_max of primary tumour and the presence of one or more positive lymph nodes were significantly associated with the overall survival. In contrast, no significant difference of prognosis was observed concerning age, sex, tumour cell type, primary site, clinical stage, primary tumour volume and length. Multivariate analysis was not performed due to the too small number of events. FDG-PET provides early prognostic informations in oesophageal carcinoma treated by radiochemotherapy.     

Les vagues de peuplements humains au Pléistocène inférieur et moyen dans le bassin de la Loire moyenne, région Centre, France. Apports de l’étude des formations fluviatiles

Evidence of earliest human settlements had been searched in the alluvial formations laid down in the Middle Loire Basin. Many stepped sheets deposited during the successive interglacial-glacial quaternary cycles are studied in four valleys of the Loire tributaries: the Creuse, Indre, Cher and Loir rivers. These sandy remnants are systematically dated, using the Electron Spin Resonance method applied on bleached fluvial quartz. Five settlements which contain very Early Palaeolithic industries with Mode 1 technology were occupied during the Lower Pleistocene. About eighty sites with hand-axe assemblages are observed in Middle Pleistocene remnants; nine of these are described in this paper. The results theorize that the geographical center of France (47°N) would be reached by two influxes of human populations with an interval around 400 years, because major climatic pejorations, particularly at the end of the Lower Pleistocene. These two populations produced lithic industries with many differences in supply of raw materials and in techniques of striking. Not any typologic link had been observed joining the two industrial unities.     

Les récentes découvertes à Baerya dans le district de Bijie, au nord de la province de Guizhou (Chine)

Fauna associated with stone artifacts have recently been uncovered, in the course of a survey from a cave site named Baerya, town land of Bijie, Guizhou province. The first observations suggest a human occupation. In the absence of chrono-stratigraphic data, it is not possible to assess the age of the site. Nevertheless the presence of lower Pleistocene fauna suggests a very ancient age for this human occupation. Further field research will be necessary to determinate the age and nature of the site.     

Entre le Nord et le Sud—un site à pointes à dos de la fin de l’Allerød : Bad Breisig, district de Ahrweiler (vallée moyenne du Rhin, RFA)

Due to unparalleled conditions of preservation below volcanic ashes of the late glacial Laacher-See volcano, the Central Rhineland region, located at the geographic hinge between the North German Lowlands and the Highland zone, permits detailed insights into the environmental and vegetational history of the Allerød-Interstadial and has produced fundamental data for the reconstruction of the way of life of hunter-gatherer groups of that time. The recently investigated site of Bad Breisig, dating to the final part of the Allerød, is the first record of a Late Glacial human settlement of the Central Rhineland after the disastrous environmental destruction caused by the eruption of the Laacher-See volcano. The site is an important chronostratigraphic and typological key in the understanding of the development of the Final Palaeolithic technocomplex with backed points in Central Europe.