Performances diagnostiques actuelles du coroscanner dans la détection de la maladie coronaire

Recent advances in multislice computed tomography (MSCT), which might represent a minimally invasive alternative to coronary angiography (CA), have allowed the ability to analyze coronary arteries. In this review, we present the current diagnostic performance of MSCT, as compared with the reference standard (CA), for the assessment of native coronary arteries, coronary in-stent restenosis and coronary artery bypass graft.     

Optimisation du protocole d’acquisition de la TEP à la fluorocholine dans la détection des lésions parathyroïdiennes

18F-Fluorocholine (FCH) PET/CT shows very promising potential for detection of hyperfunctioning parathyroid tumors. However, the optimal time to perform imaging after FCH administration has not yet been determined and protocols are highly variable. The aim of this study was to qualitatively and quantitatively compare 5, 10, 15, 20 and 60 min post-injection acquisition times in patients with primary hyperparathyroidism and equivocal traditional imaging. Thirty-one patients were included. Two observers retrospectively analyzed the five protocols. Any focal increase in FCH uptake was localized and graded on a discrete gradation scale between 1 and 5 to assess the likelihood of hyperfunctioning parathyroid tumors. Gold standard was histopathological findings for the 11 operated patients. Regarding quantitative analysis, ratio of SUVmax of parathyroid foci on SUVmean of thyroid background (as signal-to-noise ratio) were compared between protocols. After injection of 2.5 MBq/kg, FCH PET performed 60 min post-injection (2 min) had the best sensitivity and specificity by lesion (92% and 100% respectively and the best signal-to-noise ratio (median of 2). We suggest performing PET scan 60 min after injection, associated with early acquisition so as not to miss a wash-out hyperfunctioning parathyroid tumors.     

Le rôle de la taille et de la nutrition dans le déterminisme de la gemmulation chez les Spongillides

Small freshwater sponges of the species Ephydatia fluviatilis were cultivated in petri dishes, on a diet consisting of killed bacteria. They were investigated with respect to their gemmulation speed.This speed depends in a complex way on the number of gemmules from which the individual sponges have hatched, and on the nature and quantity of the diet they are fed.The hatching of a gemmule within a sponge already differentiated accelerates its gemmulation. However, this in vivo hatching is possible only in particular conditions. The sponge exerts an inhibitory influence on the hatching of any live gemmule it contains, the strength of this inhibition depending on the physiological state of the sponge.The following hypotheses can be suggested as a tentative explanation of the observed facts: (a) The onset of gemmulation would be related to the accumulation within the sponge of some kind of blastogenic material. (b) The triggering itself of the formation of gemmules would be performed by an inducer able to diffuse within the sponge and even from one sponge to another. (c) Inhibition by the sponge of the hatching of gemmules it contains would also be exerted by means of a diffusible agent, perhaps identical with the gemmulation inducer itself.The agreement between these hypotheses and the experimental and ecological data is discussed.     

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.     

Intérêt de l’imagerie hybride TEMP-TDM pour la détection du ganglion sentinelle dans les cancers du sein

IntroductionSingle-Photon Emission Computed Tomography-Computed Tomography (SPECT-CT) is an hybrid technique which associates functional and morphological images. The aim of this study was to assess the role of SPECT-CT lymphoscintigraphy in sentinel node identification in patients with breast cancer.MethodsTwelve months prospective study was undertaken. Lymphoscintigraphy comprising planar and SPECT-CT acquisition was performed in 51 consecutive patients with breast cancer (mean age: 62 ± 11.3, range: 33–83 years). Planar and SPECT-CT images were interpreted separately and the two imaging techniques were compared with respect to their ability to identify sentinel node.ResultsAn add-value of SPECT-CT images was evidenced in 31% of cases: a more accurate anatomic localization in 21% of cases and identification of undeterminate sites of uptake in 10% of cases. Furthermore, SPECT-CT detected intramammary (4% of cases) and retromammary (2% of cases) sentinel nodes missed by planar imaging. SPECT-CT was more sensitive for internal mammary drainage detection (6% of cases). The added value proved higher in obese patients. Finally, functional and anatomical images fusion and three-dimensional overview provided clear and readily usable informations to the surgeon.ConclusionHybrid SPECT-CT imaging improves the preoperative localisation of sentinel nodes in patients with breast cancer, in particular in obese patients. SPECT-CT provides readily usable informations to the surgeon.     

Cancer de la prostate : les niveaux de preuve des biomarqueurs de la détection précoce

As part of an overall review on the role of PSA and other emerging biomarkers in the detection, diagnosis and treatment of prostate cancer, we present here a part of a review of the literature made by the working group Biologie de la Prostate (AFU, CNBH, SFBC, SFMN) on the use of PSA and other biomarkers in the early detection of prostate cancer with an assessment of the level of evidence.     

Apport de la TEMP/TDM pour la détection du ganglion sentinelle dans les cancers du col utérin et de l’endomètre

The sentinel lymph node procedure is still under evaluation for the management of cervical and endometrial carcinomas. The aim of our study was to determine the diagnostic accuracy of single-photon emission computed tomography/computed tomography (SPECT/CT) for preoperative sentinel lymph node mapping in uterine cancers. Sixty-eight patients with cervical (n = 42) or endometrial carcinoma (n = 26) underwent preoperative lymphoscintigraphy for sentinel node mapping. Sentinel node detection rate with conventional planar imaging was similar to that of SPECT/CT (87.1 versus 91.8 %) in the whole cohort. However, SPECT/CT detected a higher number of sentinel nodes in more than one third of patients, affected by either cervical or endometrial carcinoma. The rate of non or insufficiently contributive procedures (lack of uptake or unilateral uptake) in endometrial carcinomas was 47 % with conventional planar imaging, and 30 % with SPECT/CT. Sensitivity of both procedures for the detection of metastatic nodes was 81.8 %, compared to 100 % for the intraoperative combined detection (gamma probe sonde and blue dye). The impact of SPECT/CT for the sentinel lymph node detection in cervical and endometrial carcinomas needs further evaluation. Nevertheless, SPECT/CT may provide additional information when conventional planar imaging detects only unilateral uptake, may improve identification of atypical localizations, and facilitate surgical approach.     

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.     

Sur le déterminisme de la formation de la grappe chez les abeilles

Conclusion Il existe une interattraction vraie chez les ouvrières d'Apis mellifica.Cette interattraction a pour point de dépárt un stimulus complexe pour une part de nature vibratoire et pour l'autre de nature olfactive.Le point de départ du stimulus olfactif se situe dans l'abdomen. Enfin pour que le stimulus soit perçu d'une manière efficace par l'abeille il faut que celle-çi soit intégrée à un groupe suffisamment nombreux.     

Considérations sur l'importance du facteur osmotioue et du facteur rapique dans le développement de la vie dans la mer noire

Sans résumé     

L'association à helichrysum stoechas dans les dunes du littoral du sud-ouest de la France

Résumé Etude floristique, écologique et systématique de l'Association à Helichrysum stoechas (Roseto-Ephedretum Kuhnholz-Lordat). Cette association thermophile est notée dans les dunes littorales due SW de la France. Elle y apparaît sur des sables calcarifères fixés en surface par une strate muscinale bien développée.