Intérêt de l’utilisation de la Prostaglandine El pour le pharmacodoppler

Doppler investigation play a more and more important role among non invasive investigations to detect penile arterial obstruction because it is simple and costless. However, continuous doppler system gives few reliable data. Pulsed doppler allows more precise investigations, reliably detecting deep vessels as cavernous arteries and, for 2nd generation system, allowing to quantify functional parameters. The association of high definition echography and colour doppler system allows to detect vessels in a more reliable and faster way, to measure arterial diameter, and reduces artefacts due to the vessel axis-probe axis angle. Nevertheless, these different investigations only give reliable and reproducible results when combined to intracavernous injection (ICI) of vasoactive drug (pharmacoldoppler). This ICI makes this procedure semi invasive and involves the risk of priapism. But it increases sensibility and specificity of the investigation by detecting arterial stenosis which are not evident in a basal state, by suggesting veno-occlusive dysfunction, and by eliminating vaso constriction due to stress. We have however to remind that, in some cases, stress can inhibit the response to ICI and so falsify pharmacodoppler results. In our center, we regularly use pulsed doppler anlysis after ICI of 10 μg of prostaglandin E1 (PGE1). The use of PGE1 increases the safety and the reliability of the investigation (less false negative results). The most reliable criteria for determination of the arterial factor seem to be the peak systolic velocity, the resistance index measured 15 minutes after ICI to appreciate the veno-occlusive factor     

Intérêt de la spectrométrie de masse de type MALDI-TOF pour l’identification des champignons filamenteux

Identification of filamentous fungi, molds and dermatophytes, is currently based on the morphological study of colonies and therefore the experience of the mycologist. These techniques are not sufficiently precise to distinguish between different species within the same section. Furthermore, identification can be delayed for several weeks due to subcultures on specific media. MALDI-TOF MS allows correct identification of filamentous fungi until the species level in more than 95% of cases in most studies. MALDI-TOF MS is a fast and precise identification technique for filamentous fungi; however most of the different databases need to be further evaluated in routine and completed to broaden the spectrum of species identified.     

Indications de la recherche des anticorps anti-spermatozoïdes

The clinical significance of antisperm antibodies (ASA) is highly controversial. A significant percentage of infertile men and women present immunity to spermatozoa, suggesting that ASA may interfere with the fertilizing capacity. ASA can act negatively on sperm parameters, sperm-cervical mucus interaction, gamete fusion and possibly also on the first step of embryonic development. ASA are present in approximately 2.8% to 26% of the male population and 0.2% to 1.6% of women. The pathogenesis of immunity to spermatozoa had not been fully elucidated: breakdown of normal protective mechanisms, i.e. blood-testis barrier, or epithelial barrier in women, and other mechanisms of immunological sperm tolerance, such as regulation of suppressor T lymphocytes. The indication for antisperm antibody testing is based on clinical and laboratory findings of infertile patients. In men, indictions for ASA testing include a history of genital disease, surgery for genital abnormalities, vasectomy, obstruction or injuries of the male genital tract, infection of accessory glands, long-standing infertility, alteration of semen parameters (agglutination, motility), mucus penetration, and reduced fertilizing capacity in IVF. In many cases, no etiological cause of autoimmunity is found and a genetic predisposition has been suggested. A majority of women do not develop antisperm antibodies, despite repeated contact with spermatozoa during their sexual life. Upper genital tract infection is the main cause of isoimmunization in females, although sexual practices, endometriosis, surgery for cervical neoplasia, recurrent spontaneous abortion and long-term infertility may also be involved. Sperm-cervical mucus impairment is the most obvious effect of immunization in women associated with IVF failure. Autoantibodies are frequently associated with antisperm antibodies. One of the consequences of the success of ICSI has been a decreased research effort to further the understanding of the origin and relevance of antisperm antibodies and specific antibody-antigen interactions. A better understanding of the natural history of immunological infertility would be useful for patient conseiling and to develop the most effective, efficient and safest management strategies. Such data could also be useful for the development of new tests and immunological methods of male contraception.     

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 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.     

Intérêt de l’imagerie nucléaire pour l’infectiologue

Nuclear imaging could be helpful for infections diseases specialists in search for bone or joint and endovascular septic foci (with or without foreign body) but also for various metastatic infectious locations and for exploring fever of unknown origin (FUO), especially in HIV-infected patients. In this paper, the interest of “conventional” scintigraphic methods (labeled leukocyte and gallium scintigraphy) and positron emission tomography coupled with fluorodeoxyglucose (FDG–PET) for the diagnosis of endovascular infections (especially those associated with foreign body) and some opportunistic diseases in HIV-infected patients (especially those presenting central nervous system involvement and FUO) will be discussed. Then other potential areas of isotopic investigations will be briefly listed; some of them, including bone and joint infections and FUO in the general population, will be presented in details in other papers in this issue.     

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.