Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis.

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

Bone scan in systemic amyloidosis.

Thirty patients diagnosed as having systemic amyloidosis (six with primary amyloidosis and 24 with secondary amyloidosis) were given bone scans with 99Tcm-methylene diphosphonate in order to evaluate the skeletal and extra-osseous uptake and their clinical-scintigraphic correlation. Extra-osseous uptake appeared in nine instances, more frequently in primary (5/6) than in secondary (4/24) amyloidosis. Fourteen patients had clinical and echocardiographic suspicion of cardiac amyloidosis but only one showed cardiac uptake. Six patients had probable hepatic involvement but in only two cases was hepatic uptake seen. The extra-osseous uptake suggests the presence of amyloid deposits in the organs and soft tissues which take up the bone tracer. The absence of any uptake does not rule out amyloid infiltration.

[The value of tomodensitometry in the treatment of carcinoma of the uterus (author's transl)]. / Intérêt de la tomodensitométrie dans le traitement du cancer du col utérin.

The authors performed pelvic and lumbo-aortic tomodensitometry (TDM) in 67 patients with invasive carcinoma of the cervix. Localisation of the cervix is aided by the insertion of a vaginal marker and by opacification of the bladder and rectum. The density and appearance of tumour tissue are identical to those of normal uterine muscle. Under such conditions, TDM is of no use in seeing partial or total involvement of the cervix without any increase in cervical size. TDM gives a clear picture of hypertrophic neoplastic cervices and may be used to obtain exact measurements. TDM offers valuable information in cases of spread to the parametrium, lymphadenopathy or visceral metastases. During radium therapy, TDM shows the relationships between the radioactive sources and the centri-pelvic tumour. It facilitates the drawing of isodose curves. TDM is not a method suitable for the early diagnosis of carcinoma of the cervix. It adds very useful complementary information to clinical examination and classical investigation.

[Locoregional extension of advanced cancer of the uterine cervix:prospective evaluation of results of clinical examination, endocavitary ultrasonography, TDM, MRI and histology]. / Extension locorégionale des cancers avancés du col utérin: évaluation prospective des résultats de l'examen clinique, des échographies endocavitaires, de la TDM, de l'IRM et de l'histologie.

Between January 1988 and January 1991, 37 advanced cervical cancer patients were operated and explorated by: clinical examination and endoluminal ultrasonography under general anesthesia (endovesical, endovaginal and endorectal US); tomodensitometry (26 cases); MR imaging (14 cases) and cytoscopy (33 cases). Results of these explorations have been compared with post-operative histopathology. Sensitivity, specificity, predictive values and accuracy of each exploration were calculated for several anatomical structures. Vesical posterior wall has been analysed in about 37 cases, vesico-vaginal structure in about 36 cases, rectal anterior wall and recto-vaginal structure in about 36 cases, parametrium and pelvic sides walls in about 35 cases. Accuracy for clinical examination, endoluminal US, TDM and IRM were respectively: 76, 85, 73, 86%, and respectively 85% by cytoscopy for vesical posterior wall; 72, 88, 65, 78% for vesico-vaginal structure; 92, 97, 83, 64% for rectal anterior wall; 78, 94, 74, 57% for recto-vaginal structure; 84, 89, 69, 73% for vagina; 81, 78, 81, 81% for parametrium; 94%, 93% and 87.5% by TDM and IRM for pelvic side wall. Contribution of endoluminal US is effective for advanced cervical cancer loco-regional staging. Endoluminal US have a good accuracy, are realised under general anesthesia without any discomfort for patients and are little expensive.

[Pilot study of screening of prostate cancer by the assay of prostate specific antigen in occupational milieu]. / Etude pilote de dépistage du cancer de la prostate par le dosage de l'antigène spécifique de la prostate en milieu professionnel.

The goal of this study was to confirm the capacity of occupational medicine to become involved in cooperative screening programs with a dosage of the PSA (Prostate Specific Antigen) determined by immunoradiometric assay. Two thousands and five hundred seventy three salaried workers in the building sector, between 50 and 65 years old, participated in this investigation. Thirty seven individual ie 1.4% had a PSA level above or equal to 10 micrograms/l. Among them, 35 were checked within three months and 17 were found to have a persistently elevated PSA level. In this subgroup 15 pathologies including two cancers were found. We observed a great variability in the results of PSA determination in the groups of individuals whose initial assay level was above or equal to 10 micrograms/l. The linear correlation coefficient between the two assays (on the same individual), carried out at a six week interval on average, was low (r = 0.52 for N = 35). In our series, 3.5% of patients followed up had undergone a rectal examination less than a year previously. Occupational medicine seems to be an efficient setting for screening intervention. However, the people mainly concerned by our study, (salaried workers seen through the physicians interviewed) did not seem very aware of this type of action.

[Iodine-125 transperineal prostate brachytherapy with preplanning technique: pre and post-implant dosimetry results analysis]. / Curiethérapie prostatique transpérinéale par iode 125 avec dosimétrie prévisionnelle: analyse des résultats dosimétriques pré- et post-implantation.

PURPOSE: Post-implant CT-based dosimetry is the only method of assessing the quality of permanent prostate brachytherapy. As a consequence of our permanent feedback with the preplanned technique, geometric and dosimetric criteria for optimal seed implantation are proposed and pre and post-implantation dosimetric results are presented. PATIENTS AND METHODS: In 2000 and 2001, one hundred and twenty patients with early stage prostate cancer were treated with transperineal I-125 preplanned brachytherapy (RAPID Strand, Amersham Health). The prescription dose was 145 Gy to the planning target volume. For the pre-planning and post-implant dosimetry the Variseed 6.7 version software was used (Varian Medical Systems). The D90, V100 and V150 values, the position of the dose peak [Dose] peak) and the full width at half maximum (FWHM) on differential dose volume histogram from both planned and post-implant dosimetry were compared for all patients. RESULTS: For preplanned dosimetry, the mean values for D90, V100, V150, [Dose] peak, FWMH were respectively of 199Gy, 100%, 70%, 220Gy, 113Gy. For post-implantation, these values became respectively of 157Gy, 90%, 62%, 220Gy, 194Gy. CONCLUSION: In our practice, differences are noted between preplanned and post-implant dosimetry parameters that should be anticipated to assure optimal definitive result. A working methodology both for performing the preplanned dosimetry and for evaluating the post-implantation dosimetric results is proposed.

Abnormal scintigraphic evolution in AA hepatic amyloidosis.

A patient with AA amyloidosis secondary to ankylosing spondylitis showed intense liver uptake of Tc-99m MDP on bone imaging. The biopsy showed hepatic amyloid deposition. A repeat bone scan with Tc-99m MDP 1 year later was negative, although the clinical signs and liver function tests of the patient had not changed. A mechanism might exist, other than the affinity of amyloid to calcium, which would explain the extraosseous uptake of pyrophosphates and diphosphonates in organs and soft tissues affected by systemic amyloidosis.

[Treatment of minor hepatic tumors with ultrasonically guided percutaneous injection of absolute alcohol. Results in 8 patients]. / Traitement de petites tumeurs hépatiques par injection per-cutanée échoguidée d'alcool absolu. Résultats chez 8 patients.

The effectiveness of ultrasonically guided percutaneous ethanol injection therapy was investigated in 8 patients who had hepatocellular carcinoma (two cases), hepatic metastases from colorectal carcinoma (five cases) and hepatic metastasis from breast carcinoma (one case). Tumor diameter was less than 5 cm in all cases. Fifty-nine ethanol injection were performed for 11 lesions. Histopathologic examination, performed in all cases, showed that the tumor was completely necrotic in 4 cases, partially necrotic in 3 cases and unchanged in 4 cases. Serum alphafetoprotein and carcinoembryogenic antigen decreased in 5 out of 8 cases. Seven patients were still alive at the end of the study with a mean follow-up period of 10.7 months. We conclude that ethanol injection may be a valuable treatment for small hepatic tumors.

[Comparative study of fine needle aspiration and large caliber needle biopsy under echographic control for the diagnosis of abdominal tumors]. / Etude comparative de la cytologie à l'aiguille fine et de la biopsie à l'aiguille de fort calibre sous contrôle échographique dans le diagnostic des tumeurs abdominales.

The aim of this study was to compare the results of fine needle aspiration (22 G) with large caliber needle biopsy (18 G) in patients suspected of having abdominal malignancy. From November 1988 to December 1989, 73 patients aged 32 to 78 years (mean 66 years), suspected sonographically of having hepatic malignancy (66 cases) or extrahepatic tumors (7 cases), underwent ultrasonography guided percutaneous fine needle aspiration (22 G) and biopsy with a large caliber needle (18 G). There were no complications. Overall sensitivity for diagnosis of malignancy was significantly better (p less than 0.01) with 18 G needle biopsies (91.2 percent) than with fine needle cytology (71.4 percent). Specificity was 100 percent. The distinction between primary and secondary malignant tumor was possible in 87.5 percent with the large caliber needle and in only 42.9 percent with the fine needle (p less than 0.001). Histological findings were adequate hepatic metastases in 86.5 percent with the 18 gauge needle and in 51.4 percent with the 22 gauge needle (p less than 0.001). In the 7 extra-hepatic tumors, the 18 G biopsy was always positive whereas fine needle cytology was positive in only 5 out of 7 cases. Correct diagnosis for benign diseases was possible in 7 out of 10 cases with the large caliber needle whereas the fine needle cytology was always negative. These results show the superiority of large caliber needle (18 G) compared to fine needle (22 G) guided punction for both diagnosis of malignancy and origin of the tumor. Complications did not occur more frequently than with fine caliber needles.

Staging of rectal cancer: a prospective study of digital examination and endosonography before and after preoperative radiotherapy.

Between January 1988 and January 1992, 34 patients with rectal cancer were evaluated both by clinical examination and endosonography before and after pre-operative radiotherapy. Two criteria were correlated with histologic findings: confinement to the rectal wall or spread beyond, the presence of mesorectal lymph node involvement. The 32 patients who underwent endosonography before radiotherapy were staged as: uT2: 4, uT3: 26, uT4: 2 cases. Fifteen days after irradiation, endosonography showed tumour regression in all cases; uT stage was different in 15 patients, uN stage in 4 cases. Comparison of the pre-operative local invasion beyond the rectal wall with postoperative histopathy revealed a correlation with: digital examination after radiotherapy in 20 of the 31 patients with palpable tumours; endosonography before irradiation in 18 of the 32 staged tumours; endosonography after irradiation in 25 of the 32 staged tumours. The presence of mesorectal lymph node involvement determined by histologic examination was correlated with the results of endosonography after radiotherapy for 22 of the 32 staged tumours. Endosonography provides a good assessment of the tumour stage before irradiation. Since radiotherapy alters endosonographic staging of rectal cancer, this staging should be included in survival studies.

[Cancer of the rectum. Results of a prospective study comparing preoperative rectal touch and transrectal ultrasonography with postoperative histopathology before and after preoperative radiotherapy]. / Cancer du rectum. Résultats d'une étude prospective comparant les données du toucher rectal et de l'échographie endo-rectale, aux données de l'histologie, avant et après radiothérapie pré-opératoire.

Between January 1988 and December 1990, 23 patients with rectal cancer were evaluated by clinical staging (23) and transrectal sonography before (22, one complete stenosis) and after radiotherapy (21). Two criteria were correlated with histological findings: a) the confinement to the rectal wall or spread beyond and b) the presence of meso-rectal lymph node involvement. The 22 patients who underwent transrectal sonography before radiotherapy were staged as uT2: 3 cases, uT3: 17 cases and uT4:2 cases. Fifteen days after irradiation, transrectal sonography showed a regression on the tumor in all cases; the uT stage was different in 9 patients but there was no change in the uN stage. The comparison of the preoperative clinical and sonographic assessment of local invasion beyond the rectal wall with postoperative histopathology revealed a correlation: a) with digital examination in 13 of the 21 patients with palpable tumors, b) with transrectal sonography before irradiation in 12 of the 22 staged tumors, c) with transrectal sonography after irradiation in 17 of the 21 staged tumors. The presence of meso-rectal lymph node involvement determined by histologic examination was correlated with the results of transrectal sonography for 14 of the 21 staged tumors. Transrectal sonography provides a good assessment of the tumor stage before irradiation. This stage should be considered for the study of survival.