Intérêt de la scintigraphie pulmonaire de perfusion dans les dilatations des bronches de l’enfant

IntroductionBronchiectasis is a chronic disease of the lungs by repeated respiratory infection. An early and adequate diagnosis and management reduce the morbidity and mortality of this disease. The aim of this study is to emphasize the importance of the combination of Computer Tomography (CT) and lung perfusion scan (SPP) in the diagnosis and therapeutic approach.Materials and methodsForty-three children were referred in the nuclear medicine department with a clinical diagnosis of bronchiectasis; they underwent a CT and a SPP.Results and conclusionBy analyzing the results of the SPP and CT separately, we conclude that there is no significant difference between the two investigations. The combination of the two explorations provides a gain in most surgical therapeutic orientation.     

Stratégies diagnostiques devant une suspicion d’embolie pulmonaire aiguë : place actuelle et perspectives de la scintigraphie pulmonaire de ventilation–perfusion

Diagnostic management of a patient with suspected acute pulmonary embolism is not based on a single and definitive test but on the application of integrated diagnostic strategies including clinical probability assessment, D-dimer, and imaging tests. Currently validated diagnostic algorithm use as cornerstone either computed tomography pulmonary angiography, or planar pulmonary ventilation–perfusion, each with advantages and drawbacks. Pulmonary single photon emission computed tomography provides interesting perspectives to position itself as an ideal alternative to these two diagnostic tests. However, the validation of a diagnostic strategy including pulmonary single photon emission computed tomography is still required.     

Etude cytochimique en ultrastructure de l'alvéole pulmonaire du rat

Résumé Les auteurs étudient par des techniques enzymatiques (phosphatases alcalines, phosphatases acides et adénosines triphosphatases) et des techniques autoradiographiques (par la glycine 3H), les cellules du revêtement de la paroi alvéolaire du rat Wistar. Après avoir rapporté les caractéristiques enzymatiques des différents types de cellules, les auteurs aboutissent à un certain nombre de conclusions concernant la cytophysiologie et le métabolisme des phospholipides au niveau du poumon.Cette étude qui fait suite à une étude histochimique et histo-enzymologique en microscopie optique, leur permet de penser que les pneumocytes granuleux ou cellules à inclusions lipidiques ou cellules alvéolaires de type II jouent un rôle particulier dans l'élaboration du surfactant. En effet, des inclusions lipidiques complexes ont été retrouvées dans les mitochondries; elles sont par ailleurs le siège d'une réaction positive par les déshydrogénases, elles incorporent précocement la glycine tritiée et possèdent une période constante de 55–56 Angströems. Les images de secrétion exocrine retrouvées permettent de penser que ces cellules synthétisent des phospholipides (au niveau des mitochondries) destinés à l'élaboration du surfactant. La positivité des A.T. Pases au niveau de leurs villosités traduit une activité de transfert énergétique au niveau des membranes.Il existerait donc deux types de figures lamellaires au niveau des cellules bordant l'alvéole: les unes sont situées dans les pneumocytes granuleux et ne sont pas positives aux phosphatases acides; elles sont surement à l'origine du surfactant. Les autres sans période caractéristique marquées par une réaction phosphatasique acide nette correspondent à du matériel phospholipidique phagocyté et sont situées dans les cellules alvéolaires ou endo-alvéolaires à activité macrophagique.

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Ultrastructural histochemical study of the rat pulmonary alveolus

Summary The alveolar cells of the rat have been studied autoradiographically (glycine 3 H) as well as with certain enzyme demonstrating methods (alkaline phosphatases, acid phosphatases and A.T. Pases). The enzymatic features of the different cell types are given and conclusions about the cytophysiology and the phospholipid metabolism in the lung are suggested.The authors think that the granular pneumocytes (or phospholipid inclusion cell or Type II alveolar cell) play a role in the surfactant elaboration. Complex lipid inclusion bodies are to be seen in the mitochondria, which are dehydrogenase positive, incorporate glycine 3H, and possess a constant structural period of 55–56 Å. The exocrine secretion figures suggest that these cells synthesize phospho-lipids in their mitochondria; these lipids are part of the surfactant. The positive A.T. Pases on the microvilli of type II alveolar cell are an indication for an active membrane transport.There are two types of lamellar bodies in the alveolar cells: the first occur in the granular pneumocyte; they are acid phosphatase negative and are certainly the source of the surfactant; the second occur in the alveolar macrophages; they do not exhibit a constant periodicity, they are acid phosphatase positive and are thought to represent engulfed phospholipids.

     

Ischémie myocardique du diabétique : apports de la scintigraphie myocardique de perfusion

Diabetes is an important risk factor of myocardial ischemia. Myocardial perfusion imaging (MPI) is used for diagnostic, prognostic assessment and for post-therapeutic follow-up of coronary artery disease (CAD). Its usefulness has been documented extensively in the general population. However, in diabetic population, little studies have been published. CAD is more severe and more frequent among diabetic patients. The goal of this work was to assess usefulness of MPI among diabetic patients. This work includes 44 diabetic patients (22 women, 22 men), investigated by stress MPI in nuclear medicine department of Ibn Rochd UH of Casablanca. The studied parameters concerned: age, antecedents of CAD, risk factors of CAD associated to diabetes, duration of the diabetes, diabetes complications, diabetes treatment, indication of MPI, presence or not of anomaly on the ECG performed at rest, existence or not of typical or atypical clinical signs of CAD, investigations and therapy prescribed as well as the occurrence or not of cardiac event during monitoring after MPI. Results of MPI have been compared to clinical, therapeutic and monitoring data of patients. Mean age of patients was 55 years (39 to 75 years), mean diabetes duration was 8.6 years (1 to 30 years), at least one diabetes complication has been noted in 18 patients. The most frequent complication was diabetic retinopathy. MPI has been achieved for diagnosis of ischemia in 37 patients and assessment of anti-ischemic treatment in 7 cases. Treadmill exercise has been achieved in 34 cases and a pharmacological stress in 10 others. During follow-up, which was between 1 and 36 months (mean: 14.9 months), 6 cardiac events occurred among the 44 patients. Patients with abnormal findings at stress MPI had two cardiovascular risk factors or more associated to diabetes (91.3% vs. 9.5% among patients having normal findings, P < 0.001) and had diabetic retinopathy more often (56.5% vs. 9.5% among patients with normal findings, P < 0.001). Cardiac events were more frequent among men (100% vs. 43.2% of patients who did not have a coronary event, P < 0.01). Patients with stress MPI showing ischemia in 3/17 segments or more have presented a cardiac event more often during the follow-up (4/12 Vs 2/32 among patients with normal MPI or defect in less than 3/17 segments, P < 0.01). In this series, coronary artery disease was found more frequently among patients having more than 2 cardiovascular risk factors. In addition, risk of cardiac event seems related to extent of uptake decrease.     

Scintigraphie cérébrale de perfusion et troubles cognitifs d’origine vasculaire

The vascular cognitive impairment (VCI) is a heterogeneous group of various etiologies, which share a presumed vascular cause. Although the age is the most important risk factor, the cardiovascular risk factors are also involved. A relatively high proportion of these cognitive disorders could be prevented or delayed. Only the treatment of arterial hypertension is recognized as a factor in preventing vascular dementia. MRI is the examination of choice for the investigation of cerebral vascular pathology. However, this morphological imaging is insufficient and does not provide useful functional information. Perfusion brain SPECT is not widely used in the exploration of VCI. Strategies for screening VCI are not standardized and long-term studies are needed to establish the better prevention of cognitive vascular disorders. This article aims to summarize the possible benefit of cerebral perfusion SPECT in the exploration of VCI.     

Diagnostic de l’embolie pulmonaire chez la femme enceinte : apport de la scintigraphie. Étude rétrospective à propos de 116 cas

IntroductionPulmonary embolism during pregnancy is a leading cause of maternal mortality. The aim of our study was to evaluate pregnant women with suspected pulmonary embolism prevalence of lesions on the lung perfusion as well as the relationship between the parenchymal lesions and various clinical factors and biological risk.MethodsThis is a retrospective study of 116 pregnant patients referred for suspected pulmonary embolism. The median age was 30 years, ranging from 15 to 47 years and the median gestational term was 31 weeks with a range of 12 to 40 weeks. Suspicion of pulmonary embolism was established with the presence of clinical signs (dyspnea, chest pain and palpitations). No patient had received a chest radiograph. The patients underwent planar perfusion scintigraphy with injected activity of 40 to 50 MBq of macroaggregates of human albumin (MAA) labeled with 99mTc. The scintigraphic results were classified according to the PIOPED criteria, depending on the likelihood of EP. The scans with low or intermediate probability were included in the same group, that of indeterminate results.ResultsThe scan was positive (with high probability) in 16 patients (13.8%), normal in 78 patients (67.2%) and classified as inconclusive in 22 patients (18.9%). In 16 patients with a positive scan, the lesions were interested the left lung in 10 cases (62.5%), the right lung in 1 case (6.25%) and were bilateral in 5 cases (31.25%).ConclusionsIn cases of suspected pulmonary embolism in a pregnant woman, the choice of imaging technique depends on both its diagnostic value and also its adverse effects. Lung scintigraphy is the examination to be carried out first in pregnant women with a chest radiograph. In others, it is that angiography should be performed as first line.     

Scintigraphie de perfusion cérébrale positionnelle : résultats physiologiques et applications cliniques

To assess the impact of standing on brain perfusion, 125 brain perfusion scans in the upright and supine position were performed, including 108 patients. Perfusion values were compared using a relative quantitative approach and a segmentation of vascular territories with the help of an atlas of brain perfusion. We found a change in the distribution of the perfusion in favor of the vertebro-basilar system in the upright position. We discuss the case of a patient whose symptoms could be explained with the help of the comparison of brain perfusion scans in the upright and supine position. Atheromatous and post-dissection stenosis and their influence on perfusion are also discussed.     

Taux de fixation de la pointe du ventricule gauche et correction d’atténuation TEMP/TDM dans la scintigraphie myocardique de perfusion chez les patients non ischémiques

Introduction

Attenuation correction (AC) has been shown to improve the accuracy of myocardial perfusion single photon emission computed scintigraphy (SPECT). It often reveals a decrease in apical uptake in the AC of the left ventricular (LV) in non-ischemic patients. We aimed to identify the parameters that could affect the apical radiotracer uptake in non-ischemic patients.

Calidad de la alimentación de adultos mayores de Santiago de Chile

IntroductionWith the increase in the elderly population of Chile, it is very important to evaluate the quality of food of this age group using simple and quick tools.ObjectiveTo compare the food quality of the elderly, according to gender and age.Material and methodsA cross sectional study was conducted on 458 elderly subjects ≥ 60 years-old of Santiago de Chile. Each one of them were interviewed in their home using the Food Quality Survey for Elderly (FQSE). The objective of this survey is to measure the quality of the food and preparations considered healthy and/or unhealthy for elderly. Weight and height, was obtained from the control document of the elderly.ResultsMen consume a higher number of unhealthy foods compared to women (P = .01). On comparing ages, those over 80 years-old consumed less unhealthy foods (P = .01). The elderly obese showed a lower score in unhealthy eating habits and total intake score.ConclusionWomen eat healthier compared to men, and better eating habits are observed at an older age, especially in men. Finally, on comparing nutritional status, the elderly obese are those who eat in the most inadequate form.     

Intérêt de la tomoscintigraphie cardiaque à la 123I-mIBG couplée à la perfusion myocardique dans le diagnostic de l’atrophie multisystématisée

ObjectiveThe aim of this prospective study is to assess the pertinence of using ¹²³I-mIBG myocardial tomoscintigraphy coupled with perfusion scintigraphy as a diagnostic tool, to discriminate between multiple system atrophy (MSA) and idiopathic Parkinson's disease (PD) at first guided by clinical data and L-DOPA tests.Material and methodsForty patients, aged from 43 to 78 years (median 62 years) with Parkinson's syndrome were studied. Nineteen had a diagnosis of PD (criteria of brain bank) and 21 AMS (Gibbs criteria). All were given test to acute L-DOPA. Chest-centered planar imaging (128 × 128 matrix, 5 minutes of duration) is performed at 1 hour and 4 hours after injection of 220 MBq of ¹²³I-mIBG, in addition a non-synchronised tomoscintigraphy (64 × 64 matrix, 32 images of 50 seconds , zoom 1.45) was performed after the 4th hour and 15 minutes after injection of 200 to 400 MBq of ^99mTc-tetrofosmin. Besides neurological data, the parameters retained for comparison purposes with ¹²³I-mIBG cardiac tomoscintigraphy were patients’ age, duration of disease and L-DOPA test results. Two regions of interest (ROI) identical in size and in shape are used for ¹²³I-mIBG uptake quantifications (H/M and washout [Wo]). The first one was placed in projection of mediastinum (M) and the other one in projection of heart (H).ResultsWe found an overall decreased uptake of the myocardial ¹²³I-mIBG without perfusion abnormality in 15 of 19 patients with PD and 11 among them were L-DOPA sensitive (L-DOPA test greater than 30%). Normal tracer uptake with ¹²³I-mIBG associated with an almost quite normal perfusion was seen in 15 of 21 patients with MSA and they were little or not L-DOPA sensitive (L-DOPA test less than 30%). Therefore, 10 discordant cases (25%) between cardiac scintigraphy and clinical evolution of disease with also discordant L-DOPA tests were observed. In the PD group, quantification of data enhanced the diagnostic decision with low heart to mediastinum ratio (H/M) (1.32 ± 0.15 at the early stage and 1.25 ± 0.13 at the later stage). In the MSA group, the uptake of ¹²³I-mIBG (1.66 ± 0.43 at the early stage and 1.72 ± 0.42 at the later stage) was comparable to literature data, however, with significant inter-individual variations. The association of data of scintigraphy with L-DOPA test allows to improve sensitivity in 84% and specificity in 90.5%.ConclusionOur prospective study of 40 cases shows the relevance of cardiac sympathetic postganglionic imaging with ¹²³I-mIBG coupled with myocardial perfusion scintigraphy to discriminate between MSA and PD with a higher sensitivity (71.4%) compared to the test with L-DOPA but a lower specificity (78.9%) than the L-DOPA. The difficulty of diagnosis is firstly linked to damage occurring to both the pre- and postganglionic sympathetic systems in patients with MSA and secondly to the integrity of the sympathetic nerve endings in patients with PD. However, the association of data of scintigraphy with L-DOPA test show a significant improvement of sensibility (84%).     

Ingesta dietética de los estudiantes de secundaria de la ciudad de Badajoz

ObjectivesTo quantify dietary intake of secondary education students in Badajoz, Spain, evaluating food frequency use in teenagers of both sexes.Material and methodsThe study sample consisted of 1197 secondary education students (49.9% male and 50.1% female). After giving informed consent, they completed a self-administered food frequency questionnaire (FFQ) including 51 food items divided into five separate categories. This questionnaire was modified from the one used at the Valencian Community in 2003 and previously validated in a pilot study on 374 students.ResultsMale and females students reported higher intakes of 70.6% and 17.6% of foods analyzed respectively, while intake of 11.8% of food items was similar in both sexes. Sex differences were statistically significant for 35% of foods (of which 72% and 28% were taken more frequently by males and females respectively). Intake of milk and dairy products appeared to be adequate, while intake of fish and seafood was low consumption of meat products was high. Intake of vegetables, fruits, bread, and cereals was below the recommended levels. Intake of pasta, rice, and oils was adequate, and there was not a high consumptio of cookies or industrial pastries. There was an excess intake of sweets, but intake of soft drinks was not high.ConclusionsThese results show intermediate values as compared to other national surveys.     

Évaluation de la cinétique globale et segmentaire du ventricule gauche chez les patients connus ou suspects de cardiopathie ischémique : comparaison des données apportées en scintigraphie de perfusion myocardique et en tomoventriculographie isotopique

Background and aimsThe analysis of the left ventricular contractile function plays a major role in the diagnosis and management of patients with cardiopathies. The aim of our study was to compare gated blood pool SPECT and myocardial perfusion scintigraphy for the assessment of the left ventricular wall contractility at the global and the segmental scales.Material and methodsThe data of 23 ^99mTc-Tetrofosmin perfusion scintigraphies, and 50 ²⁰¹Thallium perfusion scintigraphies were compared to those of gated blood pool SPECT performed at close interval.ResultsThe correlations were good (r = 0.81 to 0.94) concerning the global parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes) in the two groups. Quite good correlations were also found at the segmental scale (r = 0.49 to 0.62), between the segmental ejection fraction calculated in gated blood pool SPECT and the wall thickening or the wall motion estimated in perfusion scintigraphy. These correlations were significantly lower in the “²⁰¹Thallium perfusion scintigraphy” group than in the “^99mTc-Tetrofosmin perfusion scintigraphy” group, especially for hypokinetic segments.ConclusionAlthough they use very different approaches, GBPS and MPS give data about global and segmental left ventricular wall contraction that are well correlated, but not strictly interchangeable.     

Propuesta de desarrollo de una unidad de oncogeriatría. Tiempos de cambio: nuestra realidad

Age is one of the main risk factors for the development of cancer. It is expected that the progressive aging of the population will have an unprecedented impact on the incidence of various tumours. In fact, the management of elderly cancer patients is already a major public health problem in developed countries. However, elderly patients have systematically been excluded from cancer drug studies or protocol development. This has left health professionals in uncharted territory, without proper tools to address the multiple difficulties that arise in the treatment of these patients. A comprehensive geriatric assessment may serve as an ideal tool for the correct detection of hidden problems, facilitating treatment decisions in these complex patients, and integrating the care of patients with comorbidities.     

Effets de l'interrénalectomie sur la structure histologique de l'hypophyse et de quelques tissus de l'anguille

Résumé L'interrénalectomie, comprenant l'ablation des veines cardinales antérieures et postérieures, a été pratiquée par Monsieur Daniel Chan, chez l'Anguille Européenne. Elle ne laisse subsister que des reliquats infimes d'interrénal chez quelques individus seulement; elle permet donc l'étude des réactions histologiques d'autres glandes endocrines à la disparition des hormones corticales.L'interrénalectomie est suivie, en 8 à 9 jours, d'une hypertrophie très marquée des cellules corticotropes hypophysaires qui se dégranulent et se vacuolisent; cette réaction semble un peu plus complète en eau douce qu'en eau de mer. Elle est comparable à celle produite par les substances corticolytiques ou cortico-inhibitrices utilisées antérieurement, sans toutefois déclencher d'activité mitotique. Les restes de tissu interrénalien, malgré une image d'hyperactivité, paraissent avoir un volume insuffisant pour affecter nettement la réponse de l'hypophyse.Les Anguilles interrénalectomisées présentent simultanément une déplétion du tissu lymphoïde du rein, une stimulation des corpuscules de Stannius, une activation des cellules somatotropes de l'adénohypophyse, et une raréfaction du neurosécrétat du noyau préoptique et de la neurohypophyse. Cependant, ces modifications n'apparaissent pas spécifiques de l'ablation de l'interrénal car elles se retrouvent en partie chez les Anguilles témoins opérées, qui ont aussi des cellules corticotropes souvent hypertrophiées, un interrénal plus actif que normalement, et des cellules phéochromes volumineuses. Le système hypophyse-thyroïdien semble peu affecté 9 jours après l'exérèse de l'interrénal; les cellules à prolactine sont plus actives en eau douce qu'en eau de mer, en accord avec des résultats antérieurs, sans paraître réagir à l'insuffisance corticosurrénalienne ainsi créée.

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Summary Adrenalectomy, including the removal of the anterior and posterior cardinal veins, was performed on the European eel by Mr D. Chan. Only small remnants could be identified in a few animals. Reactions of other endocrine glands to this surgical adrenalectomy were studied.8 to 9 days after adrenalectomy, the corticotrophic cells of the pituitary gland show an hypertrophy, a degranulation and a vacuolization, these processes being perhaps more intense in freshwater than in sea water. This stimulation is similar to that produced by corticolytic or cortico-inhibiting drugs previously tested, but no mitotic activity was observed after adrenalectomy.The remnants of interrenal, which appear hyperactive, do not seem to affect the intensity of response of the hypophysial corticotrophs, probably because of being too small in size.The adrenalectomized eels have also a depleted lymphoid kidney tissue, stimulated corpuscles of Stannius, active somatotrophic cells in the proximal pars distalis, and a reduced neurosecretory material in the preoptic nucleus and the neurohypophysis. However, these last modifications do not appear characteristic of adrenalectomy, as they can be observed in the sham operated eels too. Sham adrenalectomy induces some hypertrophy of the corticotrophic cells, a stimulation of the interrenal and a volume increase of the chromaffin cells. The pituitary-thyroid axis is not clearly affected 9 days after adrenalectomy; the prolactin cells are more active in freshwater than in sea water, corroborating previous findings, but they do not appear to react to the adrenal insufficiency.

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Une partie de ce travail a été réalisée en collaboration avec le Groupe de Biologie Marine du CEA, à la Station Zoologique de Villefranche-sur-Mer. Nous remercions très vivement Mr. D. Chan, de l'Université de Sheffield, qui nous a permis de prélever les glandes endocrines des animaux qu'il a opérés. Nous remercions aussi le Dr. J. Maetz de l'accueil si amical qu'il nous a réservé dans le Groupe de Biologie Marine du CEA qu'il dirige, et le Pr P. Bougis pour les facilités de travail accordées pendant notre séjour à la Station Zoologique de Villefranche-sur-Mer. Nous exprimons notre vive reconnaissance au CEA qui a bien voulu accepter de subventionner ce travail.     

Applications de la spectrométrie de masse de type MALDI-TOF en microbiologie

In the last few years, matrix assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) has been introduced in clinical laboratories for routine identification. Initially used for research, MALDI-TOF-MS allows rapid and accurate identification of the main microorganisms isolated from clinical samples, by intact cell mass spectrometry or directly from positive blood culture or urines. Other applications are being in processed as bacterial typing, research and detection of antibiotic resistance or particularly virulent strains.