La forme scléronodulaire de la maladie de Hodgkin: expérience du CHU de Sherbrooke

Scleronodular type of Hodgkin''s disease: experience at the Centre hospitalier universitaire de SherbrookeThe nodular sclerosis type of Hodgkin''s disease appears to be a distinct clinical entity. However, the incidence, the initial localization of the tumour and the survival of the patients are variable. The present study was carried out on a group of 17 patients, all French Canadians living in the province of Quebec, from a total of 31 with Hodgkin''s disease, an incidence of 55%. There were more males (10) than females (7). The mean age of the group was 37 years, but that of the females was lower than that of the males. The mediastinum was involved at the onset in 47% of the patients. The initial staging (according to the classification of Rye) in 76% of the patients was I or II.Four patients showed disease below the diaphragm. The lungs were infiltrated three times, the spleen six times, and the liver five times. The duration of survival of the 17 patients was twice that of the patients with the three other types of the disease.     

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.     

Apports de la tomodensitométrie cardiaque dans la maladie coronaire

With the improvement of spatial and temporal resolution of the latest generations of multislice CT scanners, cardiac CT will probably take a growing role in noninvasive coronary imaging. After a short technical review, this article presents the performances and considers the actual and potential role of cardiac CT in the evaluation of coronary artery disease.     

La structure logique de la contre-épreuve expérimentale

Résumé Claude Bernard a réservé à la contre-épreuve un rôle fondamental dans le raisonnement expérimental. Il a soutenu que la seule preuve qu'un phénomène joue le rôle de cause par rapport à un autre, c'est qu'en supprimant le premier on fait cesser le second. Cependant, la contre-épreuve expérimentale n'en reste pas moins une expérimentation; la structure logique des deux, preuve et contre-épreuve, est la même. Or, si la preuve exige la contre-épreuve, la dernière à son tour exige la première comme sa contre-épreuve. On arrive ainsi à une suite infinie d'expérimentations dont chaque membre se rapporte à l'autre comme soit à sa preuve, soit à sa contre-épreuve. Cependant, ce travail expérimental, qui s'arrête dans sa réalité à un moment choisi, il est vrai, plus ou moins arbitrairement, se poursuit dans la pensée de l'expérimentateur passant ainsi des résultats individuels à leur généralisation. Au sein du raisonnement expérimental il y a donc un raisonnement analogique et c'est le sentiment du déterminisme (Claude Bernard) et la pensée causale qu'il implique plutôt que le nombre des preuves et contre-épreuves qui surgissent comme les seuls critères de la vérité expérimentale.

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Summary Claude Bernard ascribed to the counter-proof a fundamental role in his experimental method and the reasoning on which the method rests. He saw the only proof of the causal nature of a given phenomenon in the fact that the effect fails to appear after elimination of the alleged cause. However, the experimental counter-proof still remains an experiment; the logical structure of both proof and counter-proof, is the same; it is true that the proof calls for a counter-proof; but the latter in its turn calls for the proof as for its counter-proof. One thus arives at an infinite chain of experiments, each link referring to each other as to its proof or counter-proof. This experimental work, nevertheless, comes to its end, though at a moment still chosen more or less arbitrarily; the work continues however in the thought of the experimenter, thus passing from individual results to generalization. There is embodied in the experimental method and in experimental thought a reasoning by analogy. The sense of determinism (sentiment du déterminisme:Claude Bernard) and the causal thought on which this sense rests rather than the number of proofs and counter-proofs emerge as the ultimate criteria of experimental truth.

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Zusammenfassung Claude Bernard hat dem experimentellen Gegenbeweis (oder Kontrollversuch) eine hervorragende Stellung in seiner experimentellen Methode und dem ihr zugrundeliegenden Denkvorgang eingeräumt. Seiner Überzeugung nach ist der einzige Beweis der ursächlichen Natur eines Faktors darin zu suchen, dass die Wirkung ausbleibt, wenn man den als Ursache angeschuldigten Faktor ausschaltet. Indessen ist auch der experimentelle Gegenbeweis nichts anderes und nicht mehr als ein Experiment. Beide, Experiment und Gegenexperiment, haben die gleiche logische Struktur. Wenn demnach jedes Experiment den Gegenbeweis verlangt, so bedarf auch der Gegenbeweis seinerseits des Beweises als seines Gegenbeweises. So gelangt man schliesslich zu einer unendlichen Kette von Experimenten, deren jedes Glied sich zu jedem anderen wie zu seinem Beweis oder Gegenbeweis verhält. Diese experimentelle Arbeit wird aber in einem mehr oder weniger willkürlich gewählten Augenblick abgebrochen; sie wird indessen in Gedanken vom Experimentalforscher fortgesetzt, der auf diese Weise schliesslich von den Einzelresultaten zu ihrer Verallgemeinerung schreitet. Innerhalb der experimentellen Methode trifft man also auf ein Denken nach Analogie. DerBernard-sche Kausal sinn (le sentiment du déterminisme) und das diesem zurgrundeliegende kausale Denken, nicht aber die Anzahl der experimentellen Beweise und Gegenbeweise sind es, welche die letzten Kriterien der experimentellen Wahrheit enthalten.

     

Imagerie moléculaire de la maladie de Parkinson : données actuelles

During the last years, knowledge and concepts concerning Parkinson's disease and other parkinsonian syndromes have progressed: a concept of network pathology with different clinical presentations and evolutions, involving several neurotransmission pathways succeeeded the single dopaminergic lesion concept. Imaging also changed with the development of MRI. In this context, the aim of this work is to bring up-to-date methodology and clinical contribution of dopaminergic neuron imaging. Nigrostriatal neuron imaging (dopamine transporter imaging) contributes to diagnosis of Parkinson's disease and Lewy body dementia. Dopamine receptor imaging mainly helps in differential diagnosis of parkinsonian syndromes (Parkinson's disease and Parkinson plus syndromes). The ongoing development of dopaminergic, cholinergic, serotoninergic tracers and the recent emergence of amyloid plaques and neurofibrillary tangles imaging open perspectives for molecular imaging and care of neurodegenerative diseases.     

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’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.     

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.     

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.     

La détermination sérologique de la poliomyélite asymptomatique dans la famille

Résumé Dans 4 familles où se trouvait un malade atteint de poliomyélite on a examiné les sérums de la phase aiguë et de la phase de convalescence des malades et des autres membres de famille pour chercher la présence d'anticorps neutralisant trois souches du virus poliomyélitique (Lansing, SK et MM) et le virus de la chorioméningite lymphocytaire. Dans deux familles au moins, les recherches indiquent que les anticorps contre la souche Lansing ne se forment que comme conséquence spécifique d'une infection, éventuellement asymptomatique, par un virus poliomyélitique d'une structure antigène apparentée à celle de la souche Lansing. Dans une famille le sérum de la phase aiguë d'un malade et le sérum de sa mère, contenaient des anticorps tandis que le sérum de son père et d'une soeur ne neutralisait pas la souche Lansing. Dix semaines après, les sérums du père et de la soeur avaient obtenu un pouvoir neutralisant contre cette souche, bien que ni l'un ni l'autre n'aient été malades. Ceci pourrait indiquer la possibilité d'une infection par contact direct dans la famille.     

La TEP-TDM à la F-Dopa aurait-elle un rôle dans le suivi postopératoire des patients atteints de carcinome médullaire de la thyroïde ? Résultats préliminaires de l’expérience strasbourgeoise et revue de la littérature

Aim

Retrospective study to assess the value of fluorine-18 dihydroxyphenylalanine (¹⁸F-Dopa) positron emission tomography (PET)/computed tomography (CT) in the post-surgical follow-up of patients with history of medullary thyroid carcinoma (MTC) and biological suspicion of disease relapse. A review of the literature was also performed.

Patients and methods

Ten patients (23-71 years) with MTC previously treated by surgery were examined by at least one ¹⁸F-Dopa PET/CT. All patients presented with elevated serum calcitonin (130-9076 ng/l) and/or CEA (1.2-518 ng/ml) levels. 3D whole body PET/CT was performed 45 and 120 minutes after intravenous injection of 4 MBq/kg of ¹⁸F-Dopa. Scintigraphic images were visually interpreted. For quantitative analysis, maximum standardized uptake value (SUV_max) per focus was employed. PET results were compared with histological findings and/or with the results of all other imaging procedures.

Results

Seven patients (70%) had a positive ¹⁸F-Dopa PET/CT. Twenty-five focal tracer accumulations were described. Histopathological confirmation of metastatic disease was obtained in four of the seven patients with pathologic ¹⁸F-Dopa PET/CT. No scintigraphic abnormalities were evidenced in the three other patients, whose conventional morphological imaging procedures were also negatives. Delayed PET/CT examinations didn’t increase sensitivity. No correlation between ¹⁸F-Dopa PET/CT results and both serum calcitonin and CEA levels was achieved.

Conclusion

Our results are in accordance with the existing literature, showing the potential role of ¹⁸F-Dopa PET/CT in the clinical management of patients with history of MTC and biological suspicion of relapse during post-surgical follow-up. Prospective studies including larger patient series are necessary to confirm the future place of ¹⁸F-Dopa PET/CT in follow-up of MTC.