[Erectile dysfunction evaluation after brachytherapy for low risk prostate adenocarcinoma: prospective study of patients with a baseline IIEF5>16]. / Évolution de la fonction érectile après curiethérapie prostatique : étude prospective chez des patients ayant un score IIEF5 initial>16.

PURPOSE: To evaluate erectile function (EF) prospectively from 1 to 2 years post-brachytherapy in patients with a baseline IIEF5 score>16. METHODS: Between 2007 and 2012, 179 patients underwent an exclusive brachytherapy for localised low risk prostate adenocarcinoma. Neo-adjuvant hormotherapy (15.6%) and post-brachytherapy intake phosphodiesterase inhibitors (PDE5i) were not considered as exclusion criteria. EF was evaluated via a scoring questionnaire IIEF5 before the surgical implantation, at month 12 and 24 post-operation. Only patients with an initial IIEF5 score>16 were included. RESULTS: Of the 179 patients, 102 (57%) had a baseline IIEF5>16. At 12 months, 51.1% maintained an IIEF5>16 and 24.5% had a mild to moderate erectile dysfunction (ED), so that a total of 75.6% with IIEF5≥12. About 18% of patients had used PDE5i. At 24 months, 53.2% had an IIEF5>16 and 80.6% had an IIEF5≥12. Severe ED was reported in only 14.5% of the patients. The mean IIEF5 was 16.2 with an average decline of 5 points from the initial stage. All patients who were treated with PDE5i (27%) could have sexual intercourse. EF at baseline was reported as the only predictive factor of ED in multivariate analysis, 70% of patient without ED initially, had an IIEF5>16 at 1 and 2 years. CONCLUSION: Severe ED was quite rare (14%) during the first 2 years post-brachytherapy and more than half of patients maintained an IIEF5>16. The main predictive factor was the erectile function at baseline. LEVEL OF EVIDENCE: 4.

Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer.

PURPOSE: To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB). PATIENTS AND METHODS: From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I(125) PPB as monotherapy with intraoperative planning. Patients were divided into three groups-P1 (n = 64), P2 (n = 45), P3 (n = 41)-according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation). RESULTS: We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10(-5)) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008). CONCLUSION: We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters.

Visualization of the exothermal VOC adsorption in a fixed-bed activated carbon adsorber.

Activated carbon fixed beds are classically used to remove volatile organic compounds (VOCs) present in gaseous emissions. In such use, an increase of local temperature due to exothermal adsorption has been reported; some accidental fires in the carbon bed due to the removal of high concentrations of ketones have been published. In this work, removal of VOCs was performed in a laboratory-scale pilot unit. In order to visualize the increase in local temperature, the adsorption front was tracked with a flame ionization detector and the thermal wave was simultaneously visualized with an infrared camera. In extreme conditions, fire in the adsorber and the combustion of activated carbon was achieved during ketone adsorption. Data have been extracted from these experiments, including local temperature, front velocity and carbon bed combustion conditions.

[Aortoduodenal fistula revealed by acute fever with heavy and swollen red leg]. / Grosse jambe rouge aiguë fébrile révélant une fistule aorto-duodénale.

BACKGROUND: Aortoduodenal fistulas are rare and severe complications of aortic prostheses. The clinical picture usually includes digestive features and fever, unlike our observation where fistula was revealed by heavy and swollen leg with cutaneous septic abscesses but no digestive signs. PATIENTS AND METHODS: A 59 year-old man who had undergone aortoiliac prosthetic repair of an aortic aneurysm 6 years earlier was hospitalized in a dermatology department for fever beginning three months previously associated with a heavy and swollen leg. Clinical and ultrasound examination revealed vascularised cutaneous nodules on the leg. Abdominal CAT showed left iliac venous compression caused by periprosthetic inflammation and particularly retroperitoneal fluid accumulation, gas bubbles in which suggested aortoduodenal fistula, which was confirmed during surgery. Aspirative puncture of abscesses was positive for E. Coli and Candida Glabatra. DISCUSSION: Aortoduodenal fistula is a rare complication of vascular prostheses. Clinical features include digestive symptoms and fever. However, diagnosis may be difficult and delay surgery. Cutaneous manifestations appear later and are often associated with other symptoms; they are caused by septic emboli or vascular compression. Imaging methods may assist diagnosis, but surgical procedures provide confirmation and form the cornerstone of management.

Effects of metoprolol on effort angina during the postprandial state.

To determine whether beta blockers prevent the more rapid onset of effort angina during the postprandial state, metoprolol 100 mg was given before and after an 800-calorie meal in 12 male patients with stable angina and coronary artery disease. Three graded treadmill exercise tests were done daily on 2 days. After an overnight fast the first test on each day was done after a placebo to detect day-to-day variations. The second test was done 90 min after metoprolol or placebo given orally in a double-blind randomized fashion. Immediately thereafter the patients ate their meal and did their third test 30 min later. There was no significant difference between the first test on each day. After placebo the postprandial state was associated with an earlier onset of effort angina (310 and 370 sec, p less than 0.01) and with greater heart rate and systolic blood pressure rises for any work load. After metoprolol, however, there was no significant difference between the pre- and postprandial findings. During the postprandial state metoprolol delayed the onset of angina more than placebo (385 and 310 sec) and positive electrocardiogram (310 and 228 sec) and induced lowering of maximal heart rate (120 and 144 bpm) and systolic blood pressure (157 and 187 mm Hg) (p less than 0.01). Metoprolol slowed the rapid onset of effort agina during the postprandial state.

[Study of coronary perfusion by radioisotopes]. / Etude de la perfusion coronarienne par les radio-isotopes.

The study of coronary blood flow by radio isotpopes may determine the casual relationship between coronary artery narrowing and myocardial ischemia. Total coronary flow is measured without cardiac catheterisation by double counter technique using 84 Rb and by radionuclide angiography using 42 K and 113m in fixed on siderophilin. This is an easier method, which is very reproductible and which may be sensitised by atrial pacing. The measurement of regional coronary flow gives a better estimation of the physiological effects of coronary artery disease. Two indicators are used; radioactive gases (113 Xe and more recently 81 m Kr) and microspheres tracers. Selective coronary injection of biodegradable microspheres labelled with 99m Tc and 113m In may be used to assess the hyperemic reaction in the coronary arteriolar territory to the triiodide contrast media used in coronary angiography, and to estimate the reserve coronary blood flow. The transmural perfusion may be studied in animal experiments with non-biodegradable microspheres. Tomographic techniques should allow quantification of myocardial perfusion in man.

[Cardiac complications of thoracic radiotherapy]. / Complications cardiaques de la radiothérapie thoracique.

The cardiac complications of radiotherapy have been reviewed in the light of 46 case histories collected from 16 treatment centres in France. They are usually found after radiotherapy for Hodgkin's disease and carcinoma of the breast. Although histologically there may be diffuse fibrosis involving the endocardium, myocardium and pericardium, it is pericarditis which is the usual clinical feature. It often occurs late, and takes many forms. The dry constrictive fibrous type of pericarditis is the most severe because of the amount of myocardial fibrosis usually associated with it. It is rare for there to be clinical features of myocardial fibrosis, and if present they are variable: isolated disorders of repolarisation or of conduction, or true cardiomyopathies. Lesions of the coronary arteries are exceptionally rare after radiotherapy, and involve fibrosis of the intima or atherosclerosis.

[Cardiac complications of radiotherapy]. / Complications cardiaques de la radiothérapie.

Radiotherapy is an effective tool in the treatment of thoracic cancers. However, radiotherapy also carries a risk of severe cardiac complications. The cancers most commonly concerned are Hodgkin's and non-Hodgkin's lymphomas (90 per cent of cases), breast cancers, especially on the left side (4 per cent) and bronchogenic cancers (2 per cent). Ionizing radiation can damage the three layers of the heart and the coronary arteries. Pericardial involvement is the most frequent, occurring in 10 to 12 per cent of cases. It generally occurs 6 to 18 months after the radiotherapy and may present either acutely (35 per cent of cases) or chronically (65 per cent of cases). It is often latent, only detected on X-rays or on ultrasound. Constrictive forms can occur, which require pericardiectomy. Myocardial fibrosis, which is anatomically common, may present as disturbances of repolarization, arrhythmia or disturbances of conduction, or even cardiac failure. Rarely, radiation damage of the coronary arteries can cause angina or myocardial infarction. These cases can benefit from coronary artery by-pass grafts. All of these lesions have a common anatomical denominator:fibrosis, which develops progressively following the radiotherapy. It has now been demonstrated that the incidence of cardiac radiation lesions can be reduced by homogeneous distribution of the dose of radiation administered to the mediastinum, by treating each side alternately, by fractionating the radiation and staggering the sessions and by reducing the cardiac mass which is irradiated.