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.     

Conséquences de la chimiothérapie anticancéreuse sur la fertilité de la femme

Sterility is a potential toxic effect of chemotherapy. This risk is well established for alkylating agents, but is less clearly defined for anthracyclines, methotrexate and fluorouracil and poorly defined for alkaloids, platinum, etoposide and taxanes. The main predictive factors for ovarian toxicity are the additive effect of cytotoxic drugs, the cumulative dose of each drug and the patient’s age. This effect of chemotherapy is evaluated on menstrual cycles, hormonal assays and the number of pregnancies observed in patient cohorts. Chemotherapy induces destruction of oocytes and granulosa cells. In mice, it has been shown that adriamycin may induce oocyte apoptosis, which can be prevented by modulation of cycle cell signalling (dysregulation of Bax gene or, on the contrary, expression of its antagonist gene Bcl-2 or inhibition of apoptosis with sphingosine-1-phosphate or caspase inhibitors). Clinical data in the literature are usually based on retrospective studies and are somewhat confused: global fertility after MOPP chemotherapy for Hodgkin’s disease is about 20%, adjuvant chemotherapy with CMF, F(A)C or TAC for breast cancer induces amenorrhea in 50% to 70% of cases, PVB or BEP chemotherapy for ovarian germ cell tumors has little effect on fertility when the uterus and one ovary can be preserved, and the majority of women treated with methotrexate, actinomycin D or various combinations for persistent trophoblastic disease remain fertile. Preservation of fertility is a major goal for cancer patients receiving chemotherapy: in vitro fertilization could preserve the couple’s fertility, but is usually not feasible as it would delay initiation of chemotherapy until after stimulation of ovulation; oocyte or ovarian tissue cryopreservation is at the stage of research; oral contraceptives have not been demonstrated to be effective to preserve ovarian function; gonadotropin releasing hormone (GnRH) agonists prevent cyclophosphamide toxicity in rat and monkey ovaries, and a few pilot clinical studies suggest that chemotherapy-induced amenorrhea could be prevented by administration of GnRH analogues simultaneously to chemotherapy, but randomised studies are necessary.     

Utilisation de lois de la mécanique pour l'Estimationde la vitesse de locomotion des Vertébrés tétrapodes du passé

Two computation methods are explained; theirobject is the estimation of the velocity of animals which are known by their footprints, and in the case of the first method, by their skeletons as well.The first method is based on the compound pendulum theory, because during the slow walking gait, the motion of the leg is similar to the oscillation of a pendulum, for the computation of the velocity (v), are considered: moment of inertia (I), radius of gyration (P) and period (T), time in seconds to cover one stride (E) in the case the maximum angle of divarication (δ) of the leg with the vertical is ≤20°. A comparison with the formula of Alexander (1976) is discussed.The second method concerns saltator animals. It is based on the fondamental laws of dynamics. With the length of the jump (E) it is possible to estimate the velocity of the trackmaker (v) and the height of the jump (K). For the vertebrates the angle of the trajectory with the horizontal plan (α) is between 20 and 45°. Thus, the result of this method is an interval of estimation in which the velocity is included.These methods do not give precise results. But these approximations supply valid informations on the velocity of extinct or living animals and can lead to the estimation of their maximum speed if the parameters E, T, vary. The problem of the errors is also discussed. It is shown that the errors in estimating the parameters have a no significant influence on the results.     

Étude de la variabilité de la clairance hépatique de la mébrofénine-99mTc en scintigraphie hépatobiliaire

AimThe purpose of this study was to investigate some of the parameters likely to influence mebrofenin-^99mTc hepatic clearance calculation and inter-and intra-observers reproducibility.Materials and methodsHepatic clearance (%/min m²) of 30 scintigraphies was calculated from the values of hepatic, cardiac, and total activities, according to the method recommended in the literature. We studied: 1) impact of injection–acquisition delay variations; 2) acquisition type: anterior face only (FA) or geometric mean (GM); 3) clearances calculated according to four different body surface area (BSA) formulas; 4) intra-and inter-observers reproducibility for three observers (two evaluations for each observer).Results1) Clearance differences between different studied intervals were statistically significant, more important if the studied interval was far from reference interval (150–350 secondes) and even more when the interval studied was too early (110–310 secondes). 2) There was a statistically significant difference between clearance calculated using either FA or GM datasets (0.85 %/min m²). 3) There were small but statistically significant differences for four of the clearance comparisons using different BSA formulas. 4) Despite differences in size of cardiac and hepatic regions of interest (ROI), intra-observer reproducibility of hepatic clearance was excellent for each observer. Inter-observers reproducibility was also excellent (r = 0.982).ConclusionHepatic clearance of mebrofenin-^99mTc appears to be a highly reproducible method provided that acquisition and clearance calculation are standardized. It provides additionnal functional information to morphological and biological data usually performed before major hepatectomy. Thereby, the definition of a standardized protocol would enable realization of multicentric studies.     

Influence de la rhTSH sur la fixation du 18 FDG dans une population de 42 patients avec cancer différencié de la thyroïde suspect de récidive

PurposeThe role of positron emission tomography with 18 fluoro-deoxy-glucose (FDG-PET) in case of differentiated thyroid carcinoma recurrence is established. However, the influence of TSH levels on 18 FDG is still discussed. Our study aims at comparing respective performances of FDG-PET performed at low TSH levels and under rhTSH stimulation, when a recurrence of a thyroid carcinoma is suspected.Material and methodsForty-two patients have been included, in a prospective way; each of them has been explored by FDG-PET at low (PET1) and high TSH levels with Thyrogen^® (PET2). The number of hypermetabolic foci, the intensity of uptake, both visual and with Standardized Uptake Values (SUV) have been compared.ResultsPET1: 82 foci were detected, including 75 true positive (TP) and seven false positive (FP). Sensitivity by lesion is 85.23 and 58.6% on a patient basis. Twelve pathological sites, not visualized (false negative) in PET1, were seen under stimulation. PET2: 89 foci were detected, including 87 TP and two FP; two tumoral sites visualized with PET1 are not detected. Sensitivity by lesion is 97.75 and 75.9% on a patient basis. SUV are significantly higher under stimulation. In three patients, therapeutic strategy has been modified, based on PET2 data.ConclusionStimulation by rhTSH improves FDG-PET performances. Therefore, it is justified to resort to it in case of recurrence of differentiated thyroid carcinoma, when the usual workup is negative.     

Impact de la méthode de segmentation dans la caractérisation des adénocarcinomes pulmonaires en TEP-TDM au 18FDG

ObjectiveThe treatment of lung adenocarcinomas is conditioned by the presence of certain genetic abnormalities. Certain quantitative parameters obtained from FDG PET-CT, at the voxel scale, provide tumour shape and texture characteristics and might predict their mutational status. Our objective was to determine the impact of the segmentation method in the characterization of lung adenocarcinomas in FDG PET-CT.MethodsForty-nine patients with pulmonary adenocarcinomas were retrospectively included, with their initial FDG PET-CT image. The studied tumours were big, heterogeneous and difficult to segment automatically. The automatic FLAB algorithm was used with and without manual adjustment. The parameters were extracted and compared to the ALK, PDL1, and KRAS status, in order to compare the performances of the two segmentation methods. Their performance was determined by the ROC curve method.ResultsSeveral parameters were significant to predict genetic status (AUC > 0.65). The best performing parameters were different according to the genes studied and according to the resampling methods used. The results were less dependent on resampling in automatic segmentation without manual adjustment. The best performing parameters were volume dependent parameters for segmentation with manual adjustment, and texture parameters for automatic segmentation without adjustment.ConclusionThe study of texture parameters is more efficient in automatic segmentation that is not manually adjusted, and it is advantageous to use a manual adjustment when studying volume-dependent parameters in the case of very heterogeneous tumors.     

A propos de l'intervention des aéroions dans les processus de régulation de la lipémie et de la cholestérolémie

Resume Les expériences ont porté sur des lapins repartis en deux groupes parallèles — un groupe étant traité avec des aéroions négatifs en concentrations moderées (n^– = 10 – 40.000; n⁺ = 1.000) et l'autre sans aéroionothérapie (témoins). Par rapport aux animaux témoins (pas exposés aux aéroions),on a enregistré,sous l'influence de l'aéroionothérapie, que: (1)il y a une tendence de normalisation de la motilité spontanée, deprimée par une alimentation contenant un excès de cholestérol(0,3 g/kg/jour); (2) la lipémie et la cholestérolémie sont restées à un niveau plus bas chez les animaux alimentés au cholestérol; (3) la lipémie et la cholestérolémie, de même que l'iode thyroïdien, sont restées aux valeurs voisines de celles normales,chez les animaux nourris avec un excès (20 mg/kg/jour), de substances antithyroïdiennes naturelles (provenant du chou).

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Groups of rabbits were exposed to negative air ions of moderate concentrations (n^– = 10 – 40,000; n⁺ = 1,000) while others served as controls. (1) When rabbits were fed a cholesterol-rich diet (0.3 g/kg/day)causing reduction of motility in the control animals, their motility was normalized under air ion treatment. (2) The blood cholesterol and lipid levels of rabbits on a cholesterol-rich diet were lower with air ion treatment than in controls.(3) When rabbits were fed a diet with thyroid blocking agents from cabbage the blood cholesterol and lipid levels and the thyroid iodine content remained unchanged with air ion treatment.

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Zusammenfassung Gruppen Kaninchen wurden mit negativen Luftionen in mässigen Konzentrationen (n^– = 100 000 – 40 000; n⁺ = 1 000) behandelt, während andere als Kontrollen dienten. (1) Die durch Fütterung von cholesterinreicher Diät (0,3 g/kg/Tag) verminderte Motilität der Tiere wurde unter der Luftionenbehandlung normalisiert. (2) Der durch Fütterung von cholesterinreicher Diät erhöhte Blutcholesterin- und-fettspiegel fiel durch Luftionenbehandlung ab. (3) Der durch Fütterung von strumipriven Substanzen aus Kohl erhöhte Cholesterin- und Fettspiegel im Blut und verminderte Jodgehalt der Schilddrüse wurde durch Luftionenbehandlung nicht beeinflusst.

     

Perles rectangulaires gravettiennes : apport de la démarche expérimentale

The cultural facies called Final Gravettian is rare, restricted only to four reference sites located in the south half of France. Three of them yielded rectangular beads, which constitute a category of ornaments that seems to be characteristic of this late phase of the Gravettian. The series of 85 rectangular beads from the level 2 of the Abri Pataud (Dordogne) was the object of a targeted study aiming first at determining in which raw material these beads were made that turned out to be mammoth ivory for the great part. Therefore, the question of what are the techniques used to make these beads. In order to answer an experimental approach was managed with a constant dialogue with the archaeological context. This allow us to contribute to an enlarged discussion about the lifestyles of people who lived during the Final Gravettian and more precisely about the role played by the mammoth within a nomadic hunter-gatherer society with an economy essentially based on the exploitation of the reindeer.     

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.     

Quelques considérations sur l'enseignement de la médecine physique et de la réhabilitation

Particularly since World War II physical medicine and rehabilitation have assumed a growing importance. The efforts of the Canadian Association of Physical Medicine and Rehabilitation, following a survey of Canadian universities, to increase the theoretical and practical teaching of physiatrics are emphasized. It is considered important that the teaching of physical medicine and rehabilitation should be carried out concurrently with other medical and surgical teaching programs. Paramedical and auxiliary rehabilitation personnel should participate in the teaching program. The number of hours devoted to physiatrics should be increased, and the medical student should be permitted to choose physical medicine and rehabilitation as a part of his internship program.     

Effets de la radiothérapie sur la fonction testiculaire de l'adulte

Radiation therapy plays a major role in the curative management of numerous neoplasms, such as Hodgkin's disease or testicular cancer. However, the adverse effects of low-dose radiation scattered to radiosensitive normal tissues adjacent to the radiation fields, such as the testes, have been recognized. Experimental studies performed on healthy volunteers showed that no lesion was detectable on sperm counts or testicular biopsies after single doses of less than 10 cGy. Oligospermia has been reported after 15 cGy and 100 cGy result in a 90% incidence of azoospermia. In the radiotherapy of cancer, fractionated regimens are used to increase the differential effect between normal and tumoral tissues. For the same dose, a fractionated radiation regimen results in a higher incidence and a longer period of azoospermia than a single dose irradiation. Fractionated doses of >50 cGy result in a 100% incidence of azoospermia. For doses up to 200 cGy, recovery occurs but normal sperm production remains uncertain. Although the recovery time can be very long (more than 10 years), there is a risk of definitive azoospermia after doses of >200 cGy. Spermatogonia are the most radio-sensitive cell type and their depletion after small irradiation doses explain the effect of radiotherapy on fertility. Clinical hypogonadism is very unfrequent in usual practice, what seems to prove a relative radio-resistance of the Leydig cells. However, functionals studies show that there is a rise in serum LH with increasing dose to the testes. A decrease in testosterone levels has been reported after high testicular doses.     

Principes de la lecture critique de la littérature médicale: Illustration urologique

There has been an enormous expansion in scientific literature, especially in the area of health and medicine. At the same time the complexity of the research has increased. Through the reading of medical literature of his field of interest, the physician is in search of useful information. However, reading medical papers is very time consuming and most physicians, for their usual literature review, content themselves with the titles and the abstracts. Moreover, quality and relevancy of the publications vary greatly and the reader must be able to “separate the wheat from the chaff”. Thus the reading of literature needs selection and evaluation. As a result, physicians require critical appraisal skills. The principle of appraisal of medical literature is to assess the value of publications which will influence the medical practice of the reader. The reader has a double objective: to assess the credibility of the publications, and to define the applicability of the publication information. By following eight steps the reader is able to quickly rule out from his reading what is not valid and have an objective look at the quality of the results which are proposed to him. These eight steps comprise the assessment of the study objectives, the study design, the study factor(s), the outcome factor(s), the study population and sample, the confounding factor(s) and bias, the results with their statistical and clinical significance and the power of the study, and, lastly, the synthesis of the reader's judgment. The last word belongs to the clinician facing his patient.     

Valeur de la TEP-FDG dans la détection précoce des métastases osseuses : étude d’une série de 20 cas

FDG-PET is useful for metabolic analysis of metastatic cells. Based on a retrospective study relating to 20 cases of osseous metastases (MO), and a literature review, we will try to specify the main characteristics of bone metastases detected with FDG-PET. In our study, the primary malignant findings included lymphoma (n = 7), lung cancer (n = 5), breast cancer (n = 4), colon cancer (n = 2), melanoma (n = 1), and nasopharyngeal cancer (n = 1). On FDG-PET, 4 patients had a solitary metastatic focus (20%), 1 patient had two metastatic focuses (5%) and 15 patients had multiple lesions (75%). Most of the lesions showed intense abnormal uptake with SUVmax > 4.0 (14 patients, 70%); 6 patients had both intense and moderate FDG uptake with SUVmax > 2.1. Only 6 patients had MO diagnosed with standard diagnostic procedures (SDP) before FDG-PET. However, FDG-PET consistently revealed more metastatic foci missed by SDP. We conclude that FDG-PET is better than SDP in detecting all bone metastases at all sites of the skeleton according to the data of the literature.     

Étude de la cohorte nord-finlandaise de 1966: facteurs prédictifs et conséquences de la schizophrénie

Subtle motor, emotional, cognitive and behavioural abnormalities are often present in apparently healthy children and adolescents who later develop schizophrenia. This suggests that some aspects of causation are established long before psychosis becomes manifest. We aim to assess the factors contributing to the development of schizophrenia focusing mainly on genetic factors, pregnancy and delivery complications, early development and scholastic performance, as well as later educational, social and health consequences. This is done by reviewing the Northern Finland 1966 Birth Cohort, its scientific activities, publications and work in progress.     

Apports de la géologie et de la géomorphologie à l’étude du mégalithisme : identifier,interpréter,dater

The contribution of geology and geomorphology to architectural and technological study of the Atlantic coast of France megaliths is important and can be grouped into three main axes: to identify, interpret and dating. Identification refers to the sourcing of the megalithic materiel from 0 to 7 km, sometimes around 10 km, or even exceptionally around 30 km. It is never the entire supply that is affected by such long distances but only a few blocks, some of them are remarkably well staged in the megalithic architecture. Another contribution lies in a fresh look at the management of stone recognized through the modes of acquisition, transformation and use of the raw material. More particularly, the geomorphology associated with technological reading offers tools for recognizing ancient standing stones. In the context of the interpretation of funerary chambers, the two sciences open a large window on the modalities of the internal structuring of monuments. From the entrance to the end of the chamber, the organization and use of the space is documented, sometimes a symbolic coding emerges from the mineral walls. This symbolic coding is based on particular petrography, on surface conditions operating a subdivision of space, on granulometries and homogeneities of differentiated surfaces. The internal organization can also be marked with natural “patterns”, which refer to a completely new aspect of Neolithic thought. Finally, the last axis concerns relative dating, by recognizing forms of postmegalithic fossil erosion, geomorphology makes it possible to identify reused stelae. A very important tool in a current research context where an important episode of reuse of standing stones at the end of the middle Neolithic is anticipated in the construction of dolmens in the south of France.