Intérêt de la TEP-FDG dans le syndrome d’hyper-IgG4 : à propos d’un cas et revue de la littérature

Hyper-IgG4 syndrome, or IgG4-related systemic disease (IgG4-RSD), is a recently described entity of fibro-inflammatory systemic damage. Multiorgan lesions can occur synchronously or metachronously in a same patient. The common histological features include a lymphoplasmacytic infiltration (especially to IgG4), and fibrosis. Elevated serum level of IgG4 is also often present. The main concerned organs are: pancreas, biliary ducts, mediastinal lymph nodes, peritoneum, lacrimal and salivary glands. We report a case of an unusual location of this disease at the nasophyrnx in a patient of 84 years for which the diagnosis was made through immunolabelling with IgG4 in lesions biopsied, and we illustrate the potential role of PET-FDG in this systemic disease.     

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%).     

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.     

Effets d’une exposition à la Vinclozoline et à la Génistéine de la gestation à l’âge adulte sur la fonction de reproduction du ratWistar mâle: protocole et résultats préliminaires

Current evidence indicates that endocrine disrupters (EDs) can induce adverse effects on the male reproductive tract in various mammalian species. Recent reports indicate deterioration in male reproductive health in several human populations, but the evidence for a causal link with endocrine disruption is still weak. In addition, the experimental conditions of most of the reportedin vivo studies are not representative of environmental exposures (for example, high doses, short-term exposure, a single ED) and the mechanisms by which EDs disrupt the reproductive system are poorly understood. The objective of the present study is to develop an animal model to assess the reproductive effects and study the putative cellular and molecular mechanisms involved after exposure to genistein (phytoestrogen) and vinclozolin (fungicide with a known antiandrogenic potential) alone or in combination. The study will be performed in male Wistar rats, with administration of low and high doses of the compounds from conception to adulthood and a subset of the males in each treatment group will be mated with unexposed females. We plan to assess the level of sperm production, histology of the reproductive organs, motility and morphometry of spermatozoa and hormone levels, as well as DNA fragmentation of spermatozoa and determination of the number of germ cells, Sertoli cells and the diameters of seminiferous tubules. Estrogen, androgen, progesterone and FSH receptors will be detected and quantified and the level of testicular apoptosis and several apoptosis pathways will be studied to determine the putative cellular and molecular mechanisms involved. The preliminary results confirmed the developmental effects previously reported for high doses of vinclozolin. More interestingly, they indicated a number of deleterious effects for male rats exposed to low dosages alone or mixtures of low and high dosages compared to controls and rats exposed to high dosages alone. For example, a number of developmental anomalies of the genitalia were observed and a significant decrease of sperm motility and motion and fertilizing ability were observed. These preliminary results provide evidence that chronic exposure to environmental levels of EDs or mixtures of EDs have a detrimental impact on the male reproductive tract. The next step involves assessment of the anatomical disorders and the study of some of the cellular and molecular mechanisms possibly involved.     

Insuffisance rénale chronique : de la maladie osseuse à la maladie osseuse et vasculaire

The accelarated atherosclerosis occurring in patients with chronic renal failure (CRF) is a well-known complication since the beginning of dialysis. The relationship between vascular lesions and phosphocalcic abnormalities is a more recent concept. The relationship between increase in phosphate × calcium product and cardiac valvular calcifications was demonstrated in 1980. The relationship between high serum phosphate levels and mortality was shown in 1998. The strong prevalence of coronary calcifications in CRF patients was shown in 1996. In 2000, the association between these calcifications and the oral dose of calcium was strongly suggested. Thereafter, the mechanism of these calcifications appeared much more complex, involving hypercholesterolemia, inflammation, and other factors. The relationships between hyperparathyroidism and mortality were shown during the years 2000. There is also an association between hypoparathyroidism and mortality in dialysis patients but not in CRF patients before the dialysis stage. Another new concept is the discovery of a relationship between vitamin D deficiency, very frequent is CRF patients, and mortality. Treatment with active 1,25(OH)D is associated with a better survival. There is also an new interest in treatment with the 25(OH)D form since the enzyme 1-alpha-hydroxylase, which is responsible for its transformation in active form, is present in multiple organs.     

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.     

Application de la technique de PCR en temps réel à l’étude de l’ADN ancien

Real-time Polymerase Chain Reaction (PCR) for the study of ancient DNA. The properties of ancient DNA (aDNA) make difficult the retrieval of DNA sequence. The advantage of Real-Time PCR was exploited, for the first time, in the study of aDNA. We determined the optimal condition to amplify, in one round of PCR, aDNA, which should be directly sequenced. Beside the verification of aDNA authenticity, we compared two cleaning bone methods: scalpel and ethanol. The ethanol specimens showed the best DNA yield. The aDNA was extracted and amplified (mitochondrial hypervariable region I) from five skeletons exhumed from the archaeological site of Notre-Dame-du-Bourg (France), dated from 3rd to 17th century. To cite this article: R. Kefi et al., C. R. Palevol 2 (2003) 125–132.     

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.     

Influence de la congélation sur le taux de fragmentation de l’ADN des spermes normaux à sévèrement altérés

Ejaculated sperm cryopreservation can be proposed in the course of anART procedure, particularly in the case of severe oligozoospermia likely to deteriorate. The aim of this study was to evaluate the influence of the freezing-thawing process on sperm DNA fragmentation (analysed by the TUNEL technique). The first step of this work consisted of adapting the TUNEL technique to perform this analysis on very poor quality sperm. A study was then performed on 72 patients divided into 4 groups according to their spermatic characteristics: group 1 [n=20] (“normal” parameters according to WHO), group 2 [n=24] (normal sperm count associated with asthenospermia and/or teratospermia), group 3 [n=16] (total sperm count between 5 and 20 M) and group 4 [n=12] (total sperm count below 5 M). Spermatic parameters and DNA fragmentation (performed by TUNEL in situ technique, 400 spermatozoa read per slide) were evaluated on raw semen - for all patients -, raw migrated sperm - for patients of group 1 and 2 -, migrated frozen-thawed sperm - for all patients-. A TUNEL technique adapted to oligospermic samples was developed, manipulating spermatozoa directly on the slide rather than in suspension, to limit spermatic sample loss. After the whole migration-freezing-thawing process, the mean DNA fragmentation rate decreased for patients in group 1 (2.9 vs 5.1%, p<0.0001) whereas this rate increased for patients in groups 2 (10.5 vs 6.8%, p<0.0001), 3 (10.7 vs 7.6%, p<0.05) and 4 (15.2 vs 8.7%, p<0.005). DNA fragmentation rates from thawed samples were also correlated with initial spermatic parameters. At the intermediary step, migration decreased DNA fragmentation rate in comparison with raw semen rate in both groups (1.9 vs 4.7% [p<0.05] in group 1; 2.5 vs 5.4% [p<0.05] in group 2). DNA fragmentation rate decreases after migration and then increases after freezing-thawing so that this rate is lower than the raw semen rate for “normal“ sperms and higher than the raw semen rate for altered sperms. Nevertheless, this DNA damage induced by cryopreservation on altered sperms remains moderate. Sperm “resistance” to cryopreservation also appears to depend on spermatic parameters. Cryopreservation may positively select spermatozoa, accelerating elimination of senescent spermatozoa by necrosis, so that early apoptotic spermatozoa from fresh ejaculate are not found in thawed samples. These results, that need to be completed by a study on a larger sample of oligospermic patients, encourage us to continue cryopreserving severely altered sperms.     

Le Paléolithique supérieur de la région centre de l’île de Honshû

Tokai area is situated in the middle of Japan and has various configurations of ground. The eastern area has thick natural layers with volcanic ash which has been supplied from Mt. Fuji. About five chronological stages of Paleolithic culture from trapeze and edge-ground axe culture to microlith culture through backed blade culture have been found in the layers. These stages of Paleolithic culture are indicators of chronological studies in Tokai area. On the other hand, it is difficult to advance chronological studies in the middle east, middle, and west areas, because they have little thickness of layers with volcanic ash. However, different Paleolithic artifacts are found in top and bottom layers which put the AT layer between at Tsubakibora Site in Gifu Prefecture, and they have helped very much chronological studies of Paleolithic culture in the west area. Here is the first result of Paleolithic studies in Tokai area with artifacts which have been found on the forth layer of scoriae at Idemaruyama Site are dated about 35,000 years, one of the oldest Paleolithic culture in Japan. In addition, some lines of pits which were dated 30,000 years were found at Hatsunegahara Site, and they provided valuable data to study Paleolithic hunting. Finally, a holed pendant which had 10 notches on one side was unearthed from Fujiishi Site, and it was dated 19,000 years ago. At Terada and Hino Site, a flat big stone which had carvings was found, though the shape and use were seemed to be different from the pendant at Fujiishi Site.     

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.     

Intérêt pronostique de la scintigraphie au 99mTc-MAG3 pour le succès à un an de la transplantation rénale

Because of the increasing use of marginal grafts, it remains a significant difference in terms of transplants half-life between living donor or cadaver donor. The main objective of this study was to assess the prognostic value of various isotopic parameters available on the same day than surgery for the one-year outcome after kidney transplantation. A retrospective study of 100 patients, who received a renal allograft at the University Hospital of Montpellier between 1999 and 2006, and who performed ^99mTc-MAG3 renal scintigraphy within 72 h after transplantation, was performed. Measurement of various isotopic parameters was performed for angiographic and tubular phases, over three different regions of interest. According to judgment criteria, namely the success or not of transplantation after the first year, previously obtained results were statistically compared. The results of our study confirmed the importance of vascular parameters, especially the Kirchner index, with a good correlation with renal function one year after tranplantation. As expected by the physiological models, a well-perfused graft had the most chances of short-term survival. Kirchner index has a negative predictive value of more than 90% for the one-year success after transplantation (VPP = 75%). Parameters assessing more specifically nephronic functional reserve (such as tubular function slope or uptake on perfusion peaks report) are independent risk factors for the failure during the first three months.     

Hyperparathyroïdie par autonomisation d’une autogreffe de parathyroïde dans l’avant-bras : le rôle de la scintigraphie

We report the case of a 36-year old patient, referred for parathyroid imaging in a context of hyperparathyroidism. He had a history of congenital bilateral renal hypoplasia treated by four successive transplantations, the last one in July 2011. In 1990, a total parathyroidectomy with autologous parathyroid tissue graft in the right forearm has been performed for secondary hyperparathyroidism. However, hypocalcaemia persisted (2.78 mmol/L), associated with high levels of PTH (1329 pg/mL), even after the last renal transplantation. Neck ultrasound and parathyroid scintigraphy images did not show any cervical or thoracic ectopic parathyroid tissue, while right forearm incidences revealed a high uptake focus corresponding to the autonomisation of the parathyroid transplanted tissue. A brief review of the literature evaluating the benefits of this type of intervention is presented.     

Place de l’embolisation percutanée de la varicocèle dans le traitement de l’infertilité

Objectives

To describe percutaneous embolization of varicocele and to evaluate the effect on fertility disorders.

Materials and methods

One hundred nineteen patients, aged 11 to 48 years, underwent percutaneous embolization for varicocele indicated by a fertility disorder in 23% of cases. Correction of the varicocele and resolution of associated pain, improvement of testicular trophicity and the effect on fertility were studied and a review of the literature was performed.

Results

Percutaneous embolization was performed using neuroleptanalgesia on an outpatient basis. The technique combined venous sclerotherapy and placement of coils in the gonadal vein. The technique was successful in 95% of cases and one complication was observed. At 3 months, the varicocele and related pain had resolved in 98% of treated patients. According to previous reports in the literature, the relations between varicocele and fertility disorders are still unclear, but improvement of fertility (semen quality and conception rates) after varicocele repair has been established.

Conclusion

Although the consequences of varicocele on fertility have not been fully elucidated, treatment of varicocele appears to be beneficial. Percutaneous embolization of varicocele is a safe and effective alternative to surgery. This technique, based on a urological and radiological consensus, is the first-line treatment for varicocele in our institution.     

Intérêt de l’interprétation collégiale de l’échographie cervicale,de la scintigraphie 99mTc-MIBI et de la TEP-TDM à la 18-Fluorocholine dans l’hyperparathyroïdie primaire : expérience du service de médecine nucléaire de l’hôpital Cochin

ObjectivesThis study aims to assess performances of preoperative conventional imaging (99mTc-MIBI scintigraphy, cervical Ultrasonography) and 18F-fluorocholine PET/CT (FCH PET/CT) exams in the detection of hyperfunctioning parathyroid gland(s) in patients operated from primary hyperparathyroidism (pHPT).MethodsBefore surgery, 51 consecutive patients with biochemically confirmed pHPT had successively cervical ultrasonography (cUS), 99mTc-MIBI scintigraphy and FCH PET/CT, all performed in the same Nuclear Medicine Department. 99mTc-MIBI scintigraphy were performed immediatly after cUS and interpreted by same operators. FCH PET/CT exam were interpreted independently by two nuclear medicine physicians. An additional interpretation session integrating the three imaging modalities read in consensus as a combined imaging set was performed.ResultsAt surgery, 69 lesions were removed: 32 parathyroid adenoma and 37 parathyroid hyperplasia. 70% of patients had single-gland disease and 30% had multiglandular disease at histopathology analysis. In the patient-based analysis, sensitivity and accuracy in the detection of single gland disease) for FCH PET/CT, cUS and for 99mTc-MIBI scintigraphy were 86% [0.71–0.94] and 86% [0.70–0.95], 69% [0.52–0.81] and 69% [0.51–0.83], 40% [0.26–0.56] and 40% [0.24–0.58], respectively. Sensitivity and accuracy of the combined imaging set for the detection of single gland disease were 94% [0.81–0.99] and 94% [0.81–0.99].ConclusionOur results suggest that cUS/99mTc-MIBI scintigraphy and FCH PET/CT interpreted during a comprehensive session could be the ideal practice to precisely localize parathyroid lesion(s) in patients with pHPT before surgery.     

Techniques d’imagerie de la cardiopathie ischémique : le point de vue du clinicien

Coronary angiography often remains an unavoidable gold standard in cardiology practice for determining the severity, extent and prognosis of coronary artery disease and for therapeutic decision making, although established non-invasive testing – such as myocardial perfusion imaging or stress echocardiography – have demonstrated their diagnostic value and their incremental pronostic value over coronary angiography. Newer noninvasive techniques, such as multidetector computed tomography and magnetic resonance imaging, are currently being validated and will very soon be considered as alternatives to these imaging modalities in clinical practice. Facing this wide choice of tests, the cardiology community has the difficult task to determine the role and place of these various investigating techniques and to evaluate their resource implications, in other words, to optimize the cost-efficacy and ratios in the management of coronary artery disease.     

Aspects moléculaires de la spermatogenèse: la réparation post-réplication de l’ADN et le système ubiquitine

Ubiquitin is a ubiquitous and highly conserved protein of 76 amino acid residues, that can be covalently attached to cellular acceptor proteins through a multi-step enzymatic pathway. Mono- or poly-ubiquitination of proteins can lead to protein degradation or modification of protein activity. The ubiquitin system is essential to all eukaryotic cells. Many components of the complex ubiquitin system show remarkable evolutionary conservation, from yeast to mammalian species. Interestingly, during gametogenesis, many specialized and important aspects of the ubiquitin system become apparent. TheHR6B gene is a mammalian, autosomal homolog of theSaccharomyces cerevisiae geneRAD6 encoding a ubiquitin-conjugating enzyme.RAD6 in yeast is required for a variety of cellular functions, including sporulation, DNA repair, and mutagenesis. Male infertility inHR6B knockout mice is associated with impairment of spermatogenesis. Components of the ubiquitin system appear to be involved in different steps and processes during gametogenesis, including control of meiosis, and reorganization of chromatin structure.