Cancer de la prostate : la maladie localisée

Localized prostate cancer is characterized by a tumor confined to the prostate gland at clinical evaluation. Since the onset of PSA screening, the detection of localized prostate cancer has increased. Prognosis factors are clinical stadification, PSA value, PSA doubling time, tumor volume related to needle biopsy pathologic findings (Gleason score, percentage biopsies involved). Treatment depends on tumor prognosis, symptoms and performance status of the patient. Localized prostate cancer can be treated by surgery (radical prostatectomy, high intensity focused ultrasound) or radiotherapy (conformational radiation therapy, brachytherapy). Active follow-up can be proposed to very low risk patients.     

Histiocytose langerhansienne osseuse multifocale : intérêt de la scintigraphie osseuse planaire

Langerhans cell histiocytosis is a disease of the reticuloendothelial system characterized by a clonal proliferation of dendritic cells of Langerhans. This is a rare disease that primarily affects children and young adults. It can take many forms, from a single eosinophilic granuloma to widespread lesions involving multisystem life-threatening. Bone involvement is the most common, it can be uni- or multifocal. We report a case of multifocal bone Langerhans cell histiocytosis, revealed in a child aged 3 years and touched his left temporal bone and right femur. The bone scintigraphy has found a third location in right scapular. The outcome was favorable after chemotherapy. The bone lesions are characterized by lytic lesions and are responsible for pain, swelling and fractures. All the imaging techniques (radiographs, CT, and MRI) contribute to the formation of the diagnosis. Bone scintigraphy is a very sensitive examination that allows the initial staging and follow-up on treatment of skeletal manifestations.     

L’apport de la neuro-imagerie dans la maladie d’Alzheimer

Today, the role of neuroimaging in the diagnosis of Alzheimer’s disease (AD) extends beyond its traditional role of excluding other conditions such as neurosurgical lesions. Modern challenges for neuroimaging techniques aim to contribute to the early diagnosis of AD. Early diagnosis includes recognition of pre-demented conditions, such as people with mild cognitive impairment (MCI) or with high risk of developing AD. In addition, early diagnosis would allow early treatment using currently available therapies or new therapies in the future. In this article, we will present the modern role of neuroimaging in AD. Structural MRI can detect and follow the time course of medial temporal lobe atrophy as a surrogate marker for the pathological process. New MRI techniques and image analysis software can detect subtle brain diffusion, perfusion or metabolic changes thus providing new tools for studying the pathological process. New ligands are also available for studies using tracers and positron emission tomography.     

Performances diagnostiques actuelles du coroscanner dans la détection de la maladie coronaire

Recent advances in multislice computed tomography (MSCT), which might represent a minimally invasive alternative to coronary angiography (CA), have allowed the ability to analyze coronary arteries. In this review, we present the current diagnostic performance of MSCT, as compared with the reference standard (CA), for the assessment of native coronary arteries, coronary in-stent restenosis and coronary artery bypass graft.     

Sarcome d’Ewing agressif apparaissant comme une lésion froide sur la scintigraphie osseuse

Ewing's sarcoma classically presents as a hot spot on bone scan as a result of increased vascularity of the tumor and new bone formation.PurposeWe report and analyze an uncommon pattern of a “cold” lesion in Ewing's sarcoma on bone scan and its physiopathologic significance.Case reportA 15-year-old boy complaining of thigh pain. CT scan evocated Ewing's sarcoma or osteitis. MRI evocated chronic osteitis. Scintigraphy showed a fairly intense and heterogeneous uptake on the femoral lesion and no abnormal uptake elsewhere. Biopsy showed none pathologic pattern. Three months later, a second biopsy concluded to Ewing's sarcoma. Bone scan showed a larger lesion with peripheral intense uptake centered by enlarged “cold” area in the left femoral diaphysis and no evident bone metastasis. The patient underwent chemotherapy and surgery. Three months later, bone scan showed extensive skeletal metastasis.ConclusionEwing's sarcoma appears usually as an intense lesion on bone scan. Nevertheless, decreased radiopharmaceutical uptake or “cold” lesion may be seen in aggressive Ewing's sarcoma with lytic tumor, growth of which is very rapid and bony reaction is minimal.     

Nutrigénomique: cas pour un terrain commun à la maladie cardiovasculaire et au cancer

The border between health and disease is often set by a complex equilibrium between two elements genetics on one hand, lifestyle on the other, To know it better, means to give new weapons, often crucial, in the hands of the doctors and their patients. It also means to adjust therapies, to find out which drug is good for a patient and which prevention strategy will work better for him/her. Nutrigenomics is an approach to individualize or personalize food and nutrition, and ultimately health, by tailoring the food to the individual genotype. In this review, we present the interaction between certain genetic polymorphisms and diet and increased cardiovascular or cancer risk. It is, indeed, now clear that a large number of bioactive food components may provide risk or protection at several stages of both atherosclerosis and cancer formation processes. We are giving here few examples of gene-food interactions relevant for both the risk of cardiovascular disease and cancer, since a common soil could exist in the genesis of cardiovascular disease and of some types of cancer (mainly gastrointestinal tract and hormonedependent).     

À propos de quelques questions éthiques soulevées par la maladie d’Alzheimer

This paper tackles two ethical problems often raised by Alzheimer’s disease and associated disorders: the issue of diagnosis disclosure and the issue of autonomy (or consent). The first part of the paper begins with a critical analysis of the literature on diagnosis disclosure. The authors try to understand why the problem is such a hotly debated issue. They then propose some theoretical and practical perspectives. For example, they suggest that one should allow the patients themselves to designate the persons who should be informed about their health status. They also wonder whether it is really coherent to communicate the diagnosis without discussing its known consequences. The second part of the paper begins with an analytical presentation of the problems one encounters when attempting to respect the autonomy of alzheimer patients. Then the authors discuss the interests and the limits of the proposed solutions to these problems. Finally, they discuss the analyses by two contemporary philosophers (Dworkin and Jaworska) concerning the question: to what extent does Alzheimer’s disease undermine the capacity for autonomy?     

Rôle du pathologiste dans la prise en charge et le diagnostic d’une infection osseuse

The diagnosis of a bone infection is sometimes made difficult when clinical signs and imaging are not typical. In these cases, the role of a pathologist is important since he makes the diagnosis and improves the management of the infection. The main histopathological features of a bone infection and its complications, as well as the involvement of a pathologist in this pathology, are described in this article.     

Hypothèse : le modèle du lieu de rencontre pour la maladie des prions

Prions are responsible for spongiform diseases such as scrapie and bovine spongiform encephalopathy. It is now generally accepted that the disease mechanism involves the conversion from the normal form, PrP^C, to the pathogenic form, PrP^Sc, and that this isoform is infectious. In the case of scrapie, 15 different forms of the disease have been described and some of these different phenotypes can be conferred by infectious prions that are themselves encoded by normal genes. We propose here that a prion with an altered structure has a correspondingly altered preference for lipids; this altered preference creates a proteolipid domain containing different lipids and other factors such as chaperonins and enzymes responsible for post-translational modifications. Normal prions associated with this abnormal domain adopt the conformation dictated by its lipidic composition (and by the other factors present) and so acquire the lipidic preference of the original pathogenic prions. These transformed prions could then create new proteolipid domains. This process may be considered as semi-conservative replication in which prion and lipids are analogous to the Watson and Crick strands and the proteolipid domain to the double helix itself.     

La forme scléronodulaire de la maladie de Hodgkin: expérience du CHU de Sherbrooke

Scleronodular type of Hodgkin''s disease: experience at the Centre hospitalier universitaire de SherbrookeThe nodular sclerosis type of Hodgkin''s disease appears to be a distinct clinical entity. However, the incidence, the initial localization of the tumour and the survival of the patients are variable. The present study was carried out on a group of 17 patients, all French Canadians living in the province of Quebec, from a total of 31 with Hodgkin''s disease, an incidence of 55%. There were more males (10) than females (7). The mean age of the group was 37 years, but that of the females was lower than that of the males. The mediastinum was involved at the onset in 47% of the patients. The initial staging (according to the classification of Rye) in 76% of the patients was I or II.Four patients showed disease below the diaphragm. The lungs were infiltrated three times, the spleen six times, and the liver five times. The duration of survival of the 17 patients was twice that of the patients with the three other types of the disease.     

Intérêt de l’utilisation de la scintigraphie osseuse dans le diagnostic et le suivi de l’ostéochondrite primitive de la hanche

Osteochondritis, or Legg-Calvé-Perthes disease (LCP), is a necrosis of the proximal femoral epiphysis. This vascular accident entails on the complex phenomenon of growth of the child's hip and can result in deformations or even a strict destruction of the proximal femoral epiphysis. The aim of this article is to show the interest of the bone scintigraphy (BS) in precocious diagnosis and follow-up of LCP disease. In this aim, we introduced a clinical case of LCP disease where BS allowed a precocious diagnosis and a strigent monitoring. Discussion of case includes a systematic review of literature.     

Place de la scintigraphie osseuse planaire et TEMP/TDM dans l’exploration des prothèses de hanche douloureuses

Investigation of hip pain in a patient bearing a hip prosthesis is a common indication in Nuclear Medicine departments daily practice. Indeed, morphological cross-sectional imaging devices, such as MDCT and MRI, are often hampered by metallic implants. If planar bone scintigraphy is acknowledged with a high sensitivity, nonetheless, this exam specificity is poor. Since Anger cameras twinned with spiral CT (SPECT/CT) have appeared in the clinical arena, this limited specificity is compensated by the CT threefold input, all at once attenuation correction, localizing and diagnostic tool. Bone SPECT/CT requires that the Nuclear Medicine physician upgrades his knowledge of bone and joint anatomy, CT patterns, but foremost, data merging from SPECT and CT. The aim of this article is to sketch out bone SPECT/CT role and patterning in miscellaneous complications following arthroplasty, explained by pathophysiological mechanisms.