Bilan scintigraphique osseux d’une hypercondylie unilatérale

A 10-year-old girl with unilateral condylar hyperplasia was referred to our department for a bone scan. We describe the role of the bone scan in this condition. Unilateral condylar hyperplasia is a rare disease of the mandibular condyle cartilage growth leading to facial deformity. Bone scan demonstrates the active or inactive nature of condylar hyperplasia and orients therapy. A planar bone scan completed by single-photon emission computed tomography (SPECT) combined with CT was performed. Increased uptake of the left mandibular condyle, particularly well demonstrated on SPECT images, was seen. This was confirmed by relative quantification and helped decision making to surgical treatment.     

Intérêt d’une semi-quantification et d’une analyse statistique automatique pour l’interprétation de la tomoscintigraphie cérébrale de perfusion dans la maladie d’Alzheimer

IntroductionAs the visual interpretation of the brain perfusion SPECT for the diagnosis of Alzheimer's disease might be difficult, it is wished to benefit from techniques allowing to improve the diagnostic accuracy especially for the inexperienced readers.Materials and methodsThree readers retrospectively interpreted 77 ^99mTc-ECD SPECT studies within the context of suspected neurodegenerative disease. The probability of Alzheimer's disease was quoted from 1 to 5, and the optimum sensitivity and specificity values were determined from ROC curves. The readers also attributed a hypoperfusion score to 13 brain regions; a diagnosis was obtained from this semi-quantification using a simple logic rule. The SPECT scans were also analyzed using the Planet Neuro software and a diagnosis was reached from a threshold for 2 of the 90 analyzed regions. The gold standard was established by a comprehensive neurological evaluation with at least 5 years of follow-up.ResultsThe sensitivities and specificities of the three readers were 50 %, 56 %, 28 % and 76 %, 83 % and 90 %, respectively. Using the semi-quantification they were 50 %, 67 %, 61 % and 54 %, 85 %, 69 %. The results of two readers were more in agreement. Using the automatic quantification, sensitivity was 78 % and specificity 81 %.ConclusionThe semi-quantification seems to ameliorate the results of and the agreement between certain readers. However, the automatic quantification seems to be the only way of assisting all of the readers to improve their diagnostic performances.     

Étude de l’impact d’une correction d’atténuation par tomodensitométrie en scintigraphie myocardique

Myocardial perfusion SPECT is a routine for the assessment of patients with coronary artery disease (CAD). However, attenuation artifacts may decrease the specificity of the test. These artifacts can be corrected with an attenuation correction. We prospectively included 70 patients who underwent myocardial perfusion SPECT with (IRAC) and without (IRNC) attenuation correction using transmission CT imaging integrated in the acquisition system in patients with low prevalence of CAD. Automatic quantitative analysis with summed stress score (SSS) and rest (SRS) and summed difference score (SDS) was used as interpretation criteria. The results showed a specificity of 80% for IRAC and 56% for IRNC, a positive predictive value of 40% for IRAC and 23% for IRNC, without any significant change in sensitivity. An unpaired t-test showed no significant difference between the overall population and one where an artifact was corrected for heart rate and breath rate during the acquisition effort, the body mass index, chest and abdomen circumferences, and the ratio of these two parameters. Attenuation correction significantly improves the specificity of myocardial scintigraphy with no significant difference in sensitivity. The majority of corrections were for artifacts from the inferior wall in men. There is no correlation between the anthropomorphic and physiological parameters and the occurrence of an artifact of attenuation corrected with CT data.     

Indications d’une étude méiotique dans l’infertilité masculine

Meiotic investigation is rare in male infertility. Now, some mutations affecting spermatogenesis exhibit characteristic cytogenetic figures, whereas testicular histology does not show specific aspects of this pathology. In male infertility with abnormal somatic caryotype, the aim of meiotic survey is to find the mechanisms inducing spermatogenic failure, and thus to lead to a better understanding of normal spermatogenesis. In addition to cytogenetic techniques, meiosis is also investigated by electron microscopy and molecular biology. Also, we think that a larger place must be grant to meiotic study in male infertility evaluation when the indication of testicular histopathology was settled.     

L’Acheuléen saharien : Un constat et une perspective

In this document we are going to update the old data on the Saharan Acheulean, although this data isn’t plenty and all dated from the 20th century. But to resume a new era of research on the subject, it is quite obvious to evoke it. Despite the fruitful discoveries in many lower Paleolithic sites in the Sahara, no scientific interest has been brought, in particular to the numerous lithic collections interposed in several scientific research laboratories. The new Acheulean site “Tehentawek” which was discovered in the region of Idelès, in the Ahaggar, right in the heart of central Sahara, and which was excavated using new research methods, revealed in 2008 and 2010 an interesting lithic material, very representative of the Acheulean industry. The steps adopted in the study of this site are considered renovative in Saharan prehistory. Appropriate and adequate exploration of the environment, the adaptation of field work to the rocky context of the Ahaggar region, allowed us to reconsider the Saharan terrain. The technological study of lithic material has provided a variety of tools containing choppers, hand axes and cleavers, as well as many raw flakes, sometimes compatible with the nucleus. The lithic raw materials used for shaping are local. The results of the analyzes carried out on the sediments collected can lead to a discussion on the Saharan palaeoenvironment.     

Une nouvelle observation d’une métastase testiculaire d’un adénocarcinome prostatique: Aspects diagnostiques et éthiopathogéniques

Testicular metastases from prostatic adenocarcinoma are rare. They are often asymptomatic and diagnosed incidentally or at autopsy after orchidectomy in more advanced stages of the disease. The authors report a new case and review the diagnosis and aetiopathogenesis of these metastases. A 67-year-old patient with prostatic adenocarcinoma presented with painless right testicular mass for two months with no inflammatory signs. Germ cell tumour serum markers were negative. Scrotal ultrasound showed a large testicular tumour measuring 7×4×3cm. Histological examination revealed a solid non-differentiated tumour, not suggestive of primary testicular tumour. The immunohistochemical panel confirmed the prostate as the primary site due to the positivity of cytokeratins, PSA and PSAP and the negativity of classical markers of germ cell tumours. Testicular metastases from prostatic adenocarcinoma are rare, but their incidence is currently on the increase. They are often asymptomatic and discovered after pulpectomy. This diagnosis must be considered in the case of a testicular mass in patients over the age of 50 with a history of prostatic adenocarcinoma. The diagnosis was established after orchidectomy by histological examination and immunohistochemical tests.     

Impact d’une réduction d’activité sur la mesure de la fraction d’éjection du ventricule gauche sur caméra D-SPECT

IntroductionRadionuclide ventriculography provides a reproducible measurement of the left ventricular fraction ejection (LVEF) but with a significant body radiation (effective dose of 5,9 mSv for the injection of 850 Mbq of ^99mTc). The highly sensitive semi-conductor (CZT) cameras could allow decreasing the injected activity by a factor 3, similarly to that of myocardial perfusion imaging. Our study was aimed to determine whether the LVEF measurement provided by radionuclide ventriculography on the CZT D-SPECT camera is impacted by a 70% reduction in recorded counts.Materials and methodsAfter the in vivo labeling of red blood cells with 850 MBq of ^99mTc, 49 patients completed a conventional 2D recording (Conv-2D) on Anger camera followed by a 3D recording on the D-SPECT camera (3D-100%). The CZT recordings of all projections were subsequently shortened to 30% of their initial durations (3D-30%) in order to assess the LVEF measured with a 70% reduction in recorded counts.ResultsMean LVEF values were 62.7 ± 11.1% on Conv-2D and higher on both 3D-100% (66.8 ± 14.8%, P < 0.001) and 3D-30% (66.3 ± 15.7%, P < 0.001). The correlation coefficients with the LVEF determined with the reference Conv-2D method were equivalents for 3D-100% (r² = 0.73) and 3D-30% (r² = 0.70) and with a similar level of overestimation for the highest LEVF values.ConclusionA 70% reduction in recorded counts does not significantly impact the LVEF measured with radionuclide ventriculography on the CZT D-SPECT camera. These values are coherent with those obtained with the reference 2D method but with a clear overestimation for the highest LVEF values.     

Les lésions de l’urètre associées à une fracture des corps caverneux. A propos d’une série de 4 cas et revue de la littérature

Introduction

Urethral injury associated with corpora cavernosa fracture is a relatively uncommon form of urological trauma. Early diagnosis and immediate surgical repair are essential.

Patients and methods

Between January 1990 and December 2004, a total of 4 male patients with urethral injury associated with fracture of the corpora cavernosa were retrospectively studied from a series of 96 cases of penile fracture.

Results

The mean age of the patients was 36.5 years (range: 27–45 years). Urethral bleeding was noted in all patients. Immediate surgical repair via a penile circular subcoronal incision was performed in all cases. Two partial urethral injuries associated with a unilateral corpus cavernosum lesion were identified. In the other cases, total urethral injury was associated with bilateral rupture of the corpora cavernosa. The tunica albuginea defect was closed and the urethral laceration repaired over a urethral catheter. With a mean follow-up of 2.5 years, 2 short urethral strictures were observed and were managed non-operatively with good outcome.

Comments

Secondary urethral lesions associated with corpora cavernosa fracture most frequently affect young adults. In North African countries, forced self-manipulation of an erect penis is the most frequent cause, but the associated urethral lesion is usually related to vaginal intercourse. The diagnosis can generally be made on the basis of history and physical examination alone. Blood at the meatus or haematuria or voiding difficulties suggest associated trauma to the urethra [4]. Additional imaging examinations are rarely required. The standard treatment is prompt surgical exploration, evacuation of haematoma, and primary repair of the urethral and corpora cavernosa defects. Late complications after surgical repair are penile curvature and pain during coitus. They are usually attributable to a residual fibrotic area.

Conclusion

Urethral injury associated with corpora cavernosa fracture usually has typical signs. The mechanism of trauma is very suggestive. Early surgical treatment is the only guarantee of a satisfactory functional result.     

L’ischémie du gland: une complication de la circoncision sous bloc pénien

Dorsal penile nerve block is a common procedure and can provide effective analgesia after penile surgery. Ischaemic complications are rare and generally result from trauma or inadvertent administration of vasoconstrictor solutions. We describe a case of glans penis ischaemia in a 15-year-old male after dorsal penile nerve block with lidocaine 2% and bupivacaine 5% for circumcision. The event occurred nearly 12 hours after the procedure. This was successfully treated with intravenous infusion of lloprost (a PGI2 analogue) and oral administration of pentoxifylline. The appearance returned to normal after 72 hours. This rare complication associated with circumcision and dorsal penile nerve block is reviewed and discussed.     

Développement d’un dispositif expérimental ultrasonore pour le largage ciblé et contrôlé d’une chimiothérapie encapsulée

Applying ultrasound on drug-loaded sonosensitive liposomes offers new possibilities for treating cancer. In vitro experiments were performed in the present study to define an index of inertial cavitation which could be used to monitor the delivery of drugs. This index could also be used to assess the sonosensitivity of new formulations of liposomes. Experiments were then carried out in rats bearing subcutaneous abdominal tumors. Based on pharmacokinetic and biodistribution studies, a period of 48 hours was chosen between the injection of the liposomes and the exposure to ultrasound. At the injected doses, liposomes slowed down significantly the tumor development. Ultrasound combined with liposomes seemed to contribute to the tumor control. However, the important efficacy of liposomes alone and the eventual weak interactions with ultrasound prevent to guarantee that the effect of ultrasound is significant.     

Comparaison des populations de Culicoides Latreille 1809 (Diptera : Ceratopogonidae) présentes au sein d’une bergerie belge et d’une prairie ovine associée

Culicoides biting midges (Diptera: Ceratopogonidae) serve as biological vectors for several pathogens, including the Bluetongue virus and the recently described Schmallenberg virus in northern Europe. These diseases have caused considerable direct and indirect economic losses to the sheep and cattle industries. This study undertaken between August and December 2007 on a sheep farm in the Namur province (Belgium) aims to evaluate Culicoides populations present inside a partially opened sheepfold and in a nearby sheep meadow, using light traps. The comparative analysis of insects trapped at 18 dates at regular intervals showed that Culicoides were most abundant inside this livestock building (17,450 midges) than in surrounding meadow (1,121 midges); this meadow had however a greater species diversity. The two species C. obsoletus and C. scoticus constituting the Obsoletus complex predominated for all trappings and females were much more numerous than males. Important capture of engorged females of the Obsoletus complex inside the sheepfold seems to reflect the possibility of an opportunistic endophagous behavior. Maintaining sheep inside livestock buildings in order to reduce the risk of Culicoides bites – and thus of pathogens transmission – however requires to limit biting midge populations which are likely to enter or to develop inside these buildings. Implementation of effective sanitation and hygiene measures against midges present inside farms, as well as establishing of measures to protect livestock against intrusion and improvement of “midge-proofing” of animal housing are therefore highly recommended.     

Comment je raisonne devant une masse rétropéritonéale

The retroperitoneal masses are various and heterogeneous and include tumors from different organs (kidneys), the primary retroperitoneal tumors and metastasis. The primary retroperitoneal tumors are rare, frequently malignant with a delayed diagnosis. More than half of them are sarcoma. Rarity and heterogeneity of retroperitoneal tumors explain the difficulties of diagnostic. The goal of this article is to review the imaging characteristics of CT scan and RMN of retroperitoneal mass and to clarify the diagnosis. The management of sarcoma requires an expert multidisciplinary team (pathologist, radiologist, surgeon, oncologist) and pathology analysis by retroperitoneal transcutaneous biopsy.     

Pour une histoire du désir

The striking feature of the history of sexual desire is the contrast between the omnipresence of sexual desire in human societies, regardless of the period considered, and the negative representation constantly and systematically given to this desire by philosophers and religious leaders. Sexual desire was automatically rejected by those who were disgusted by the animal side of man. The Stoics of the first century A.D., rapidly followed by theologians of the young Christian religion, were convinced that animals only act to satisfy their physical needs, but that moral man had to distinguish himself from the animals by refusing to act simply for pleasure. For Cicero and Seneca “seeking an act because of the pleasure it procures is an abuse”. They applied this principle to food as well as bodily care: unthinking animals live to eat, while moral humans eat to live; food and maintenance of the body ensure health but do not provide pleasure. Similarly, sexuality is only justified for reproductive purposes. However, as already observed by Saint Augustine, this is not the way in which human beings act, and this Church Father had to admit that he had never met a husband able to claim that he “only had sexual intercourse in the hope of fathering”. Other thinkers were more moderate and distinguished acceptable desire, kept under the control of reason and leading to positive action from degrading, irrational desire ending in passion (always considered to be unreasonable). Only the second form of desire must be avoided; the first leads to happiness and fulfilment and remains the force that usually drives human action. Christian thinkers of the Middle Ages, attentive to the real life of believers, finally accepted that the human characteristic of memory is one of the most beautiful gifts of God, allowing man to remember past pleasures and therefore to rightfully experience the desire to repeat these pleasures: coitus without a reproductive purpose therefore appears to be part of the divine plan. A theologian, in contrast with dominant religious opinion, even declared “if someone eats a pear or a beautiful fruit only for the pleasure, it is not a sin. The same applies when a man has intercourse with his wife only for the pleasure”. However, far from theoretical discussions, individuals declared their deep attachment to desire, during the Renaissance, at the court of the Sun King, in salons of the Enlightenment or even, in contrast with a widely held belief, in the new industrial world of the 19th century. Today, while religious authorities still generally have a Stoic view of pleasure and desire, modern thought has advanced in its understanding of the place of desire in human experience and recognizes it an essential driving role responsible for fulfilment and a powerful stimulus for all forms of creativity. The history of sexual desire therefore corresponds to the steps of enrichment of basic animal instinct by the human species and the individual and social forms of expression of this desire.