Performances de la TEP au 18F-FDG dans la caractérisation initiale de la lésion primitive du cancer du sein

Objective¹⁸F-FDG PET/CT is for the moment not recommended for stage T of the TNM classification of breast cancer. The aim of our study was to evaluate the performance of ¹⁸F-FDG PET/CT in the initial staging of breast tumors. Tumor size, skin involvement and inflammation as well as the relationship between primary tumor maximum standardized uptake value (SUVmax) and histopathological grade (SBR), molecular tumor subtypes (luminal A and B, Her2 enriched, triple negative), estrogen receptors (ER), progesterone receptors (PR) and focality were evaluated.MethodsHistological reports of patients operated for breast cancer, without neoadjuvant chemotherapy, were compared to preoperative ¹⁸F-FDG PET/CT.ResultsSeventy-four patients who underwent surgery in 2016 were included. ¹⁸F-FDG PET/CT was able to visualize primary tumors in 91% and to correctly classify the T stage of the TNM classification in 81% of the cases, to detect multifocality in 73% and cutaneous and inflammatory breast cancers in 100%. The uptake intensity of ¹⁸F-FDG (SUVmax) was significantly correlated with histo-prognostic factors such as SBR grade (P = 0.02), lack of expression of estrogen receptors (ER) (P = 0.01) and progesterone (PR) (P = 0.02), positive HER2 status (P = 0.01) or triple negative subtype tumors (P = 0.02).Conclusion¹⁸F-FDG PET/CT provides relevant elements for local assessment, in particular, tumor focality and inflammatory character in addition to ensuring the regional and extension assessment.     

Le déficit androgénique lié à l’âge: du diagnostic biologique au traitement substitutif

There is increasing interest in the assessment of testicular function in aging men, probably because of an increasing number of males above 60 years and because of the emerging gap in the medical management of aging between men and women. In the last three decades, the endocrinological problems of menopause have been thoroughly taken into consideration, while the decline in testis activity in the so called andropause was only recently recognized to deserve a similar interest. In fact, testis endocrine function is not so easy to evaluate in elderly men: total testosterone (tT) level declines very slowly and it is a fallacious index of testis function because of the increase in testosterone/estradiol binding globulin (TeBG) levels in aging males. Free testosterone level is an accurate index when measured by reference techniques, while routine direct assays using testosterone analogues have been proven to be unreliable diagnostic tools. The measurement of bioavailable testosterone (bT) after ammonium sulfate precipitation of TeBG-bound testosterone is currently considered as the method of choice for diagnosing ADAM syndrome. Indeed, in aging males, bT levels are more closely correlated than tT with bone mineral density, muscle strength and muscle mass. Bioavailable estradiol is also a reliable index of testis aging in elderly males and is strongly correlated with bone mineral density. Unfortunately a serious expertise is needed for accurate measurement of bioavailable estradiol levels. Another difficulty in the diagnosis of ADAM syndrome in the uncertainty in the bT threshold to be taken into account. The 5th percentile of bT levels in young adult men can be arbitrarily choosen; however, there is no definite proof that such a threshold is totally appropriate, since no data are available regarding the evolution with years of androgen receptor sensitivity. Nevertheless, identifying androgen deficiency by means of bT measurement may lead to hormone replacement therapy, at least as a therapeutic test. Several formulations of testosterone are currently available using oral, intra-muscular and transdermal routes. Testosterone undecanoate (Pantestone®) is given orally and is supposed to reach the blood stream via the lymph thoracic channel. Intra-muscular testosterone in oil (Androtardyl® and Testosterone Heptylate®) can maintain high testosterone levels for two to three weeks, but can also induce supra-physiological levels of testosterone and dihydrotestosterone (DHT) within the first week after injection. Transdermal formulations have been recently proposed as non-invasive ways to administer testosterone while by-passing liver metabolism. Permeation enhanced transdermal system (Androderm®) can mimic the testosterone circadian rythm, but testosterone levels may be supra-physiological for several hours. DHT levels however are generally maintained whithin physiological values. Testosterone gel (Androgel®) can induce stable and physiological levels of testosterone, DHT and estradiol. Care should be taken to avoid contamination of the familial environment by testosterone after its application. The choice between these formulations depends obviously on the patient’s needs, the patient’s requests, and the patient’s compliance with a particular formulation.     

Le trouble déficit de l’attention-hyperactivité et ses relations avec les conduites addictives

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric comorbidity in substance use disorders. The aim of this article is to review the link between ADHD and addictive disorders. For this purpose, we will describe the clinical symptomatology of ADHD in adults and the prevalence of addiction in this population. We will broach the explanatory models for this comorbidity. Finally, we will evoke the long-term consequences of psychostimulant treatment in children with ADHD and the current treatment recommendations for substance users suffering from ADHD.     

Mesure de l’exposition externe au cours de la détection peropératoire. Expérience du service de médecine nucléaire de l’hôpital Ibn Sina

Nationally, the department of nuclear medicine, Ibn Sina Hospital is the first service that started with the technique of isotopic labeling for the treatment of osteoid osteoma and identification of sentinel lymph node. However, the operating room is a place where the staff is not familiar with the handling of radioactive substances. The intraoperative detection in these places leads the staff working there to ask some questions related to radiation safety. In this work, we have implemented the radiation protection aspects of these acts by the measurement of external exposure of personnel involved and we confirmed that the dosimetric measurements are negligible.     

Pour une approche « neurocognitive « de la mémoire: apport de la neuropsychologie

Cognitive models suggest that memory consists of potentially independant modules. In addition, clinical data lead to a reference to the central systems that interact with these operative modules, and which assign significance and pertinence to the information being processed. Such an organization fits better with clinicial data, since it can be demonstrated with the example of episodic or procedural memories as both require the activation of strategic processes, under the control of the prefrontal cortex, needed for the organization or the control of the information to be processed.     

La technique de débitage au Paléolithique supérieur de l’archipel du Japon

The representative debitage technique is the one of the culture of knife-to-back in the name of the superior Paleolithic of Japan. She/it can be he divided in two, the one of the first half and the one of the second half. The first corresponds at the time of apparition, either to the stage of launching of the technique of debitage laminaire whose debitage didn’t provide elaborate blades being little successive. As for the stage of fortifying of the debitage laminaire, the industries lithic to knife-to-back of the Sugikubo type developed themselves in the oriental Honshû. With regard to the region of Kantô to the second half of the first where the knife-to-back of Moro type mingled equally with those while shaping on the blade. To the recent stage of development, one can note the industry lithic to knife-to-back of Moro type is based on the technical very blady in the western Japan. Succeeding in the second half of the superior Paleolithic that the technique of debitage of Sétoüchi developed itself in this part whose debitage is characterized by the strut oblong in wing, are the transverse blades These gotten supports used especially for making the knife-to-back of Koü type while spilling country-wide. To the second recent half, the technical blade of Sunagawa type took place in all regions of Japan except the inshore regions of the Interior Sea of Séto and the region of Kinki (Kyoto-Osaka).     

Seuil thermique de développement de trois coccinelles prédatrices de la cochenille du manioc au congo

Résumé Le seuil thermique de développement de 3 prédateurs de la famille desCoccinellidae (un exotique et deux locaux) a été étudié. L'équation de la constante thermique a été utilisée pour le calcul du seuil thermique. Les données obtenues ont été comparées entre elles. L'espèce exotiqueHyperaspis raynevali a un seuil thermique de développement plus bas que celui des 2 espèces locales (Hyperaspis senegalensis hottentotta etExochomus flaviventris). Le seuil thermique suivant a été obtenu pour chaque espèce, à savoir: 11,81°C pourH. raynevali; 13,78°C pourH. s. hottentotta; 13,63°C pourE. flaviventris. Des différences de seuil thermique de développement et de mortalité ont été enregistrées entre le prédateur exotique et les espèces indigènes. Des hypothèses explicatives sont évoquées dans la discussion.      

Mesure de l’exposition externe du personnel du service de médecine nucléaire de l’hôpital Ibn Sina de Rabat au cours de la manipulation des radiopharmaceutiques

The nuclear medicine department of Ibn Sina hospital was created in 1965. Its first location was in radiology department, and then it was transferred in 1977 to the old emergency unit. The conception was not originally dedicated for a nuclear medicine department. To reassure the medical staff about their exposition during radiopharmaceutical manipulation, a dosimetric study was performed in collaboration with the National center of radiation protection (CNRP). Dosimetric monitoring was conducted for 3 months with the use of passive thermoluminescent dosimeters, (Harshow, 6600 plus), covering all categories of staff. The administration of 153 Samarium has been also studied. Other cases of people concerned our study: a pregnant woman doctor, whose exposure of the unborn child must be reduced as much as possible, and a woman from a private company, working occasionally in the department. To control the conditions imposed on all activities requiring exposure to ionizing radiation, we evaluated the dose at the extremities of operators with the use of ring dosimeters (Harshow 6600 plus) and the dose on the ambient environment of staff. This experiment has shown exposure levels below legal limits, without been negligible for some workstations. Technicians equivalent doses results justify the wearing of dosimeter rings as a complementary dosimeter in nuclear medicine department. Finally, monitoring ambient dosimetry showed that the environment measurements are in keeping with national and international norms. The Medical staff was very interested by this study, which demonstrates that radiation protection standards are respected through awareness, basic training, continuing education and information. The first author is particularly involved in the practical procedures in order to respect radiation protection recommendations for restraining staff annual chest and extremities dosimetry figures within regulations values.     

Efficacité de la mémoire associative inhérente à la potentiation post-tétanique

An associative memory is modeled in networks of cells that are assumed to have the short-term plasticity of the neuromuscular junction of the frog. The data relating synaptic transmission efficiency and stimulation frequency for post-tetanic potentiation of the neuromuscular junction are represented by polynomial expansions. Simulation of storage and retrieval demonstrates that functional associative memory is feasible based on this particular synaptic plasticity. Retrieval reaches a maximum efficiency at a delay of three minutes after storage and is lost after about 9 min. The signal to noise ratio of the retrieved pattern drops steadily as additional associations are stored in memory but retrieval appears to be possible with up to four stored associations. Although the data are derived from synapses not normally proposed as a basis for memory functions, the results here will generalize to other synaptic junctions located more centrally that have similar characteristics. This simulation technique allows the efficiency of associative memory based on various types of synaptic plasticity to be evaluated.     

Comparaison de différents indices métaboliques et de la méthode SULTAN dans l’évaluation de la réponse thérapeutique par TEP au 18FDG dans le cancer du sein métastatique

Objective18F-FDG PET is a valuable tool in the evaluation of therapeutic response in breast cancer. This retrospective study was designed to compare the performance of six metabolic indices and to define their optimal thresholds, in patients treated with chemotherapy or hormone therapy for metastatic breast cancer. The performances of a parametric analysis by SULTAN method were also evaluated.MethodsTwenty patients, who underwent from 2 to 7 PET during the follow-up were analyzed. For each target, six indices were measured: SUVmax (maximum Standardized Uptake Value), SUVpeak, SAM (Standardized Added Metabolic activity), metabolic volume (MV), SUVmean using an adaptive threshold, and TLG (total lesion glycolysis). The percentage change of each target between each PET was calculated. A method based on parametric imaging (SULTAN) was also applied to each patient. The results were compared to the gold standard, defined by clinical evaluation, biological and morphological imaging RECIST 1.1 criteria. A per-lesion and per-patient analysis were performed and the optimal thresholds for each indices were calculated.ResultsFor the per-lesion analysis, 61 targets and 111 evolutions with 67 responders (R) and 44 non-responders (NR) were studied. Using ROC curve analysis and intercomparison, SUVmax, SUVpeak and SUVmean were significantly better than SAM, TLG and VM (P < 0.05). Using the optimal thresholds of −21%, –21%, –34%, –48% and –23% for SUVmax, SUVpeak, SUVmean, SAM and TLG respectively, these five indices were significantly correlated with the gold standard. SUVmax, SUVpeak and SUVmean showed the best performances of sensitivity (88%, 87% and 78% respectively), specificity (93%, 93% and 98% respectively) and negative predictive value (NPV) (84%, 69% and 74% respectively). For the per-patient analysis, 42 pairs of PET with 22 R and 20 NR were studied. Only SUVmax and SUVpeak were correlated to gold standard with the 30%-PERCIST-threshold and with optimal thresholds with performances of sensitivity of 73% and 77%, specificity of 95% and NPV of 76% and 79%. Parametric analysis with SULTAN showed excellent performances in the per-lesion and per-patient analysis (sensitivity 84% and 82%, specificity 98% and 90%, NPV 80% and 82%, respectively).ConclusionSUVmax and SUVpeak appeared the best indices to evaluate metabolic response in metastatic breast cancer. The SULTAN method was a reliable method to assist interpretation.     

Les enjeux de l’intégration de l’automate d’immunohématologie AutoVue d’Ortho-Clinical Diagnostics au sein du laboratoire

Evaluation des critères de sécurité, productivité et conformité à la réglementation. L’automatisation de la paillasse d’immuno-hématologie au laboratoire est une démarche dont l’objectif est d’optimiser les contraintes organisationnelles et économiques tout en préservant la qualité des résultats par l’utilisation des techniques analytiques de référence dans un cadre sécuritaire et réglementaire de haut niveau.