Intérêt du dosage de la testostérone biodisponible dans les dysérections

Is serum non-sex hormone binding globulin-bound (non-SHBG-bound) testosterone more sensitive than total testosterone (T) in men presenting érectile dysfonction? Non-SHBG-bound testosterone level has been shown to undergo decrease whereas SHBG level increases in middle-aged men without érectile dysfonction. Serum SHBG increase has been found in secondary organic etiology of érectile dysfonction. The aim of this work was to study hormonal status in men presenting érectile dysfonction. Serum SHBG, T, bioavailable T, luteinizing hormone (LH) and folliculin stimulating hormone (FSH) levels were measured in 40 men presenting érectile dysfonction. They were divided into four groups according to their etiology: psychogenic, vasculogenic, iatrogenic, and unknown etiologies. In order to consider the effect of the age, each group was compared with age-related healthy controls without any érectile dysfonction. Non-SHBG-bound-T decreased with age and SHBG increased, while serum T was similar in young and elderly control subjects. In the vasculogenic subjects, SHBG was higher than in the controls, but not significantly. In the patients with érectile dysfonction of unknown etiologies, non-SHBG-bound-T was lower than in the controls without increase of SHBG. In the psychogenic patients, SHBG was higher than in the controls while total T was similar in both groups. This study allowed to investigate androgen status of men suffering of érectile dysfonction according to their etiology. The following step would be to study the rate of success of appropriate hormonal therapy in patients in which peripheral hypogonadism occurs.     

Intérêt du dosage des peptides natriurétiques en urgence dans la dyspnée aiguë

Acute dyspnea often leads to an emergency room visit. B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP) are natriuretic peptide factors secreted by ventricular myocytes when pressure is exerted on the ventricular wall. BNP fights against the activation of the renin-angiotensin-aldosterone system, while NT-proBNP exhibits no activity in this regard. Elevated blood levels of these factors correlate with a variety of functional indices for left-sided heart failure. Several studies have demonstrated their usefulness as markers of left-sided heart failure, the main cause of acute dyspnea seen in emergency rooms. The diagnostic performance of BNP and NT-proBNP appears to be identical; it is, however, greater than that of the emergency room physician. BNP and NT-proBNP have high sensitivity and specificity in the diagnosis of acute heart failure. Briefly, when BNP is less than 100 pg/ml, heart failure is very unlikely (NT-proBNP <500 pg/ml); when it is greater than 400 pg/ml (NT-proBNP >2000 pg/ml); when it is greater than 400 pg/ml (NT-proBNP >2000 pg/ml), it is very likely. The early measurement of BNP in emergency room situations improves the care of patients presenting with acute dyspnea and makes it possible to reduce hospitalisation costs.     

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.     

Intérêt de la TEP dans le bilan d’extension et l’évaluation de la maladie résiduelle des séminomes testiculaires : étude rétrospective

AimsTo evaluate the value of PET/CT comparatively to CT in staging and restaging after chemotherapy of testicular seminoma, to assess quantitative methods and prognostic value of PET in post-chemotherapy residual masses.MethodsThirty-two patients and a maximum of 65 targeted lesions visualized on PET-CT and CT performed for staging and therapeutic response assessment were analysed and compared. Each lesion was quantified according to miscellaneous SUV normalized methods. Optimal threshold of SUV for prediction of residual disease was obtained (ROC method). The prognostic value of PET/CT at the completion of treatment was determined with progression free survival study (Kaplan-Meier method).ResultsPET/CT exhibited higher accuracy than CT in the initial staging and assessment of therapeutic response, respectively 98% versus 83.3% and 95.1% versus 75.6%. Quantification, whichever method, was not more efficient than visual reading for prediction of residual disease. Progression-free survival was higher with negative than with positive PET/CT (P = 0.0033).ConclusionOur work demonstrates that PET/CT exhibits better accuracy than CT in both staging and restaging at the end of treatment. Quantification methods do not improve accuracy of PET/CT for prediction of viable residual disease. The prognostic value of PET/CT appears very promising and needs to be confirmed by large prospective studies. PET/CT appears to be a relevant method of prognostic stratification of the risk of relapse in seminoma.     

Intérêt du dosage de l’inhibine B et de l’AMH dans le plasma séminal: étude préliminaire

Objectives

The aim of this study was to establish reference values for seminal inhibin B and AMH concentrations in patients with normal and abnormal sperm parameters. Preliminary analysis was performed to evaluate the predictive value of these markers for retrieving testicular sperm in non-obstructive azoospermic men.

Methods

Seminal inhibin B and AMH concentrations were assayed by an enzyme-linked immunoassay in three groups of men: 47 patients with normal sperm parameters, 28 oligospermic men and 68 patients with azoospermia.

Results

Inhibin B and AMH concentrations varied considerably in the three groups, but were significantly higher in normospermic men (inhibin B: 714.36±522.66 ng/l, AMH: 97.08±135.15 pmol/l) than in oligospermic men (inhibin B: 417.5±386.9 ng/l, AMH: 62.02±93.33 pmol/l) and azoospermic men (59.61±2.65 ng/l et 13.12±31.94 pmol/l, respectively) (p<0.001). A significant correlation (p=0.0054) was observed between seminal inhibin B concentration and sperm production. Testicular biopsy allowed sperm retrieval in 11 out of 21 patients (52.3%). The predictive value of seminal inhibin B was analyzed using receiver operating characteristics (ROC) curve analysis. The best discriminating inhibin B concentration was 30 ng/l with an area under the curve (AUC) of 0.63.

Conclusion

This study confirms the correlation between seminal inhibin B and AMH concentrations and spermatogenesis. However, the significance of these two markers as predictors of the presence of testicular sperm in men with non-obstructive azoospermia is limited. This analysis shows that AMH and inhibin B, either alone or in combination with serum FSH, fail to predict the presence of sperm in men with non-obstructive azoospermia undergoing testicular sperm extraction.     

Intérêt de l’introduction à la nomenclature du test de détection des HPV

Le cancer du col de l’utérus reste un problème de santé publique puisque 900 000 nouveaux cas sont diagnostiqués chaque année de par le monde [Luthra] et il est responsable en France de plus de 1600 décès par an. Pourtant, depuis plus de 40 ans, le dépistage de masse des précurseurs du cancer invasif est tout à fait réalisable et le traitement des anomalies cervicales pré-invasives amène généralement à la guérison.     

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.     

Intérêt de l’imagerie hybride TEMP/TDM pour la scintigraphie des récepteurs de la somatostatine dans le bilan des tumeurs endocrines gastro-entéro-pancréatiques

In this work, we have evaluated the potential of image fusion and attenuation correction (AC) of SPECT-CT imaging for the assessment of gastro-entero-pancreatic endocrine tumors by somatostatin receptor scintigraphy (SRS).MethodAfter optimisation of acquisition and reconstruction parameters, we have evaluated, in a prospective study, SRS performed over a period of one year. We have compared visual interpretations of planar and tomographic images versus SPECT/CT images to determine if anatomical localisation and diagnostic contributions are improved. In a semi-quantitative analysis of pathological foci, we have measured maximal intensity values (T_max), tumour to background ratios (T/B) and tumour contrasts (Ct) with and without AC.ResultsIn 25 SRS, visual analysis has shown anatomical localisation improvements in 60% of cases (CI95%, 39–79) and diagnostic improvements in 64% of cases (CI95%, 43–82). Doubtful foci proportion changed from 44 to 11%. In the semi-quantitative analysis of 41 pathological foci, Wilcoxon matched-pairs tests showed significantly higher T_max, T/B and Ct values after AC.ConclusionSPECT/CT imaging improves diagnostic quality of SRS thanks to a better foci localisation and a better lesional contrast in the image.