How reproducible are classical and new CT-pelvimetry measurements?

PURPOSE: The objective of this study was to assess the reliability and reproducibility of existing and new computed tomography (CT)-pelvimetry measurements. MATERIAL AND METHODS: A retrospective cohort study of 63 women with a mean age of 33.9±5.2 (SD) years (range: 19-49 years) was conducted. Classical pelvimetry measurements were collected including the obstetric conjugate (OC), median transverse diameter (MTD), and interspinous diameter (ISD). Additionally, we used multiplanar reconstruction (MPR) mode to define two oblique planes: inlet pelvic plane (IPP) and mid-pelvic plane (MPP) and measure new pelvic parameters, including anteroposterior (APD), transverse diameters and circumference of both IPP and MPP (inletAPD, inletMTD, inletCIRC and midAPD, ISD, midCIRC, respectively). The reproducibility (intra- and inter-observer) of our results were assessed. Multivariate analyses using principal component analysis and clustering methods were conducted to analyze the association between pelvimetry measurements and identify patient sub-groups. RESULTS: All linear measurements (OC, inletAPD, MTD, inletMTD, midAPD, and ISD) showed statistically "almost perfect" intra- and inter-observer correlation coefficients (range: 0.924-0.980). Circumferences (inletCIRC and midCIRC) showed statistically "almost perfect" intra- (range: 0.847-0.857) and inter-observer correlation coefficients (range: 0.923-0.957). The measurement of 6 pelvimetric parameters allowed determining three groups of pelvis size. CONCLUSION: New pelvic measurements have excellent reproducibility and are similar to the classical measurements, based on the MPR analysis of CT planes adjusted to the inner bony pelvis.

A canine vaccine against Leptospira serovars Icterohaemorrhagiae, Canicola and Grippotyphosa provides cross protection against Leptospira serovar Copenhageni.

Efficacy of the Leptospira components of multivalent vaccine DAPPi-L was previously demonstrated against virulent challenge with three serovars of Leptospira interrogans (Canicola, Icterohaemorrhagiae and Grippotyphosa) carried out 14 days after primary vaccination. In this study we demonstrate that this vaccine provides, two weeks after vaccination, an additional protection (prevention of mortality, clinical signs, renal infection, bacterial excretion, renal carriage and renal lesions) against fatal leptospirosis due to Leptospira interrogans serovar Copenhageni (serovar of major medical importance).

A common gesture with a rare but potentially severe complication: Re-expansion pulmonary edema following chest tube drainage.

BACKGROUND: Primary Spontaneous Pneumothorax (PSP) is usually considered as a benign pathology occurring in young people. In about half of cases, observation only is purposed. In case of intervention, chest tube drainage remains the preponderant strategy even if no studies conclude about superiority of drainage or aspiration. Re-expansion pulmonary edema (REPE) is a rare but potentially severe complication of chest tube drainage. Risk factors are not well identified, but REPE is more frequent for patients with diabetes, younger than 40 years, with large pneumothorax, lung collapse more than one week and fast re-expansion. CASE REPORT: We report a case of a 19-year old male presenting to the Emergency Department with a first episode of PSP. He was treated by chest tube drainage with immediate suction. He developed a REPE 3 hours after chest tube drainage with suction. Conservative management and oxygen therapy led to withdrawing the chest tube 9 days later. CONCLUSION: For the initial management of PSP, prevention of this complication is essential. In case of risk factors, prevention consist of absence of immediate suction after chest tube drainage and suction should be reserved in case of failure of initial treatment after 24 hours. Even if chest tube drainage is a common gesture, clinical presentation of REPE must alert physicians taking care of these patients.

Tubulocystic renal cell carcinoma: a new radiological entity.

UNLABELLED: Tubulocystic renal cell carcinoma (TC-RCC) is a recently identified renal malignancy. While approximately 100 cases of TC-RCC have been reported in the pathology literature, imaging features have not yet been clearly described. The purpose of this review is to describe the main radiologic features of this rare sub-type of RCC on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), based jointly on the literature and findings from a multi-institutional retrospective HIPAA-compliant review of pathology and imaging databases. Using a combination of sonographic and CT/MRI features, diagnosis of TC-RCC appeared to be strongly suggested in many cases. KEY POINTS: • Tubulocystic renal cell carcinoma is a new entity with typical imaging features • Diagnosis of tubulocystic renal cell carcinoma can be suggested preoperatively by imaging • Cystic renal lesions with high echogenicity may correspond to tubulocystic carcinoma.

Tumor necrosis after preventive embolization of large renal angiomyolipomas.

OBJECTIVES: The purpose of this study was to retrospectively evaluate tumor necrosis following preventive embolization in patients with renal angiomyolipoma (RAML) at high risk of bleeding. PATIENTS AND METHODS: Arterial embolization was performed in 24 patients (22 women, 2 men; mean age, 43±13 years) with a total of 30 RAMLs (mean volume, 137 cm(3)±163) between 1996 and 2012. Two sub-groups of patients were identified and further compared based on the presence or not of necrosis following arterial embolization. RESULTS: The technical and clinical success rates of arterial embolization of RAMLs were 97% and 87%, respectively. The mean initial volume of RAMLs differed between the two sub-groups with 331 cm(3) in the group with tumor necrosis and 88 cm(3) in the group without tumor necrosis (P=0.0047). High-fat content RAMLs were predominantly observed in the necrosis group and the mean volume reduction observed for high-fat RAMLs was 65% whereas it was 36% for low-fat content RAMLs. The six patients who developed RAML necrosis had arterial embolization using microspheres (one patient with microspheres alone and five with a combination of microspheres and metallic coils). All necrotic RAMLs displayed arterial dysplasia. CONCLUSION: The risk of tumor necrosis is higher for larger RAMLs. The role of distal arterial embolization with microspheres in tumor necrosis in RAML is suggested by the results of our study but could not be definitely demonstrated statistically due to the limited sample size.

[Imaging of urothelial carcinomas of the upper tract: state of the art review for the yearly scientific report of the National French Association of Urology]. / Imagerie des tumeurs des voies excrétrices supérieures: état de l'art pour le rapport scientifique annuel de l'Association française d'urologie.

OBJECTIVE: To propose a state of the art regarding imaging techniques for the diagnosis and work-up of upper tract urothelial carcinoma (UTUC). METHODS: A systematic review of the scientific literature was performed in the Medline database (PubMed) until 2014 using different associations of the following keywords: urothelial carcinomas; upper urinary tract; ureter; renal pelvis; CT scan; MRI; ultrasound; urography. RESULTS: Imaging has a prominent role in the diagnosis, extension and follow-up assessment of upper tract urothelial cancers (UTUC). The couple ultrasound/intravenous urography made way for the multidetector computed tomography urography (MDCTU) and for the magnetic resonance imaging urography (MRU), which can also be combined in some cases. This review of the literature presents available techniques for the exploration of the upper urinary tract, the main protocols (in particular the interest of furosemide addition), details the interpretation techniques for searching UTUC on serial imaging, as well as the main differential diagnoses, and their accuracy. Finally, the role of imaging, according to patient's context is discussed. The combination or fusion of different modalities (CT, MR…) for the same objective is highlighted and presented as the likely evolution of UTUC imaging. CONCLUSION: MDCTU is nowadays the gold standard imaging modality for the diagnosis of UTUC.

Prostate cancer: diagnosis, parametric imaging and standardized report.

Multiparametric MR of the prostate provides an extremely accurate diagnosis and offers an excellent negative predictive value for cancers which biopsies struggle to detect. Combined with biopsies they consolidate both positive and negative biopsy results and allow patients to be offered more appropriate treatments (active monitoring, radical treatment in full knowledge of the topography of the lesions involved, or local treatment, etc.). The investigation does not require advanced equipment and can be carried out in any MR centre although it needs to follow a technical protocol described in the European guidelines (ESUR 2012). Interpretation should be standardized to facilitate communication of clear and consistent information between practitioners.

[Andrological description of a population of azoospermic men with agenesis of the vas deferens]. / Description andrologique d'une population azoosperme avec une agénésie des canaux déférents consultant pour infertilité.

CONTEXT: In the 1990's, congenital agenesis of the vas deferens was identified as a minor form of cystic fibrosis in relation to the frequency of mutations of the CFTR gene associated. It is responsible for masculine infertility by obstructive azoospermia; which is not accessible to a surgical treatment. However, surgical sperm retrieval and injection de spermatozoïde en intracytopasmique (ICSI) allow fatherhood for these patients. PATIENTS AND METHODS: A retrospective analysis of 104 consecutive patients from 1996 to 2006. A comprehensive clinical, spermiologic, hormonal, imaging and genetic workup was carried on. The data from the surgical extractions and the attempts of ICSI were collected. RESULTS: Seventy-five percent of the patients had a mutation of the CFTR gene; ultrasound imaging revealed a renal or a seminal vesicle abnormality in 20% and 84.5% of the patients, respectively. The association of a semen volume less than 2 mL with a pH less than 7.2, a fructose less than 2 and mean sudoral chlore greater than 60 mmol/L enabled an immediate identification of 30% of patients carrier of the mutation and without renal abnormality. The sperm extraction rate was 98%. CONCLUSION: A search for the CFTR gene mutations and an ultrasound imaging of the genito-urinary system are essential to the workup of these patients. The association of a semen volume less than 2 mL, a semen pH less than 7.2 and a fructose less than 2 must point towards a minor form of cystic fibrosis and prompt the workup of genetic abnormalities and sudoral chlore testing. The results of the sperm extraction combined to the technical advances of IVF/ICSI allow excellent pregnancy rates of 66% for the companions of these patients.

Prostate MRI: can we do without DCE sequences in 2013?

Multiparametric MRI (mp-MRI) of the prostate currently provides stable and reproducible performances. The usefulness of dynamic contrast-enhanced (DCE) sequences is currently challenged, as they sometimes only confirm what has already been observed on diffusion-weighted imaging (DWI) and require the additional purchase of a contrast agent. Eliminating these sequences may help accelerate the use of MRI in addition to, or in lieu of, prostate biopsies in selected patients. However, many studies show that these sequences can detect lesions invisible on T2-weighted and diffusion-weighted images, better assess cancer extension and aggressiveness, and finally help detecting recurrence after treatment. We present the various applications of dynamic MRI and discuss the possible consequences of its omission from the current protocol.

Significance of ADC value for detection and characterization of urothelial carcinoma of upper urinary tract using diffusion-weighted MRI.

PURPOSE: To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics of upper urinary tract urothelial carcinomas (UTUCs). MATERIALS AND METHODS: We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with apparent diffusion coefficient (ADC) maps calculated between b = 0 and b = 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours were compared with that of normal renal parenchyma using an unpaired Student's t test. Association between ADC values and histological features was tested using non-parametric tests. RESULTS: Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (p = 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (p < 0.001). No statistical association was found between ADC values and pathological features (location, p = 0.35; grade, p = 0.98; muscle-invasive disease, p = 0.76 and locally advanced stage, p = 0.57). CONCLUSION: DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need further investigations in a large prospective multi-institutional study.

[Small renal masses: 10 years of treatment in a tertiary referral center in cancer research]. / Cancer du rein de moins de 4cm : traitement dans un centre de référence régional en cancérologie.

OBJECTIVES: To analyze the impact of preoperative clinical data that could influence the undertaking of small renal masses (size<4cm) and to direct patients towards surgery or observance or radiofrequency. PATIENTS AND METHODS: From January 2000 to December 2010, 253 small renal masses were included in a retrospective study. Renal masses less than 3cm were compared to the 3 to 4cm masses. Clinical data, pathological data and follow-up was noted prospectively on the database and we analyzed it according to the treatment done (surgery, radiofrequency or observation). RESULTS: Surgical treatment, radiofrequency and observation were performed for 214 (86.4%), 15 (5.9%), and 24 (9.5%) patients respectively. The treatments of the patients differed in the two groups (<3cm vs. 3-4cm) and the appeal to radiofrequency and observation was more frequent for elder patients (>65years old) and for those whom performance status (ECOG status) greater or equal to 1. Cancer specific survival was not statistically different for the two groups (average: 87.5% after 5years, mean 33months follow-up, P=0.7). Independent risk factors of recurrence were Fuhrman grade, synchronous tumors, noddles invasion and metastatic progression. Positive surgical margins were not a risk factor of recurrence (P=0.6). CONCLUSION: Age and performance status are the two main clinical data, which influence the treatment for patients with small renal masses. Radiofrequency and observation were undertaken more regularly for elder and altered ones. The use of scales as Charlson Index or Lee scale could help to choose more easily according to global morbidity and mortality.

An African horse sickness virus serotype 4 recombinant canarypox virus vaccine elicits specific cell-mediated immune responses in horses.

A recombinant canarypox virus vectored vaccine co-expressing synthetic genes encoding outer capsid proteins, VP2 and VP5, of African horse sickness virus (AHSV) serotype 4 (ALVAC(®)-AHSV4) has been demonstrated to fully protect horses against homologous challenge with virulent field virus. Guthrie et al. (2009) detected weak and variable titres of neutralizing antibody (ranging from <10 to 40) 8 weeks after vaccination leading us to hypothesize that there could be a participation of cell mediated immunity (CMI) in protection against AHSV4. The present study aimed at characterizing the CMI induced by the experimental ALVAC(®)-AHSV4 vaccine. Six horses received two vaccinations twenty-eight days apart and three horses remained unvaccinated. The detection of VP2/VP5 specific IFN-γ responses was assessed by enzyme linked immune spot (ELISpot) assay and clearly demonstrated that all ALVAC(®)-AHSV4 vaccinated horses developed significant IFN-γ production compared to unvaccinated horses. More detailed immune responses obtained by flow cytometry demonstrated that ALVAC(®)-AHSV4 vaccinations induced immune cells, mainly CD8(+) T cells, able to recognize multiple T-epitopes through all VP2 and only the N-terminus sequence of VP5. Neither VP2 nor VP5 specific IFN-γ responses were detected in unvaccinated horses. Overall, our data demonstrated that an experimental recombinant canarypox based vaccine induced significant CMI specific for both VP2 and VP5 proteins of AHSV4.

Detecting prostate cancer with MRI - why and how.

Multiparametric MRI of the prostate is an essential examination for the diagnosis, preoperative evaluation and planning of treatment for prostate cancer. This examination can accurately detect cancer foci in the gland so that the most appropriate management can be offered, reduce the risk of over-treatment and also ensure that certain aggressive lesions or unusual locations, which might affect the prognosis, are not ignored. We present here its main indications, focusing on the techniques for interpreting MRI, its performance and its limitations, as well as the recent European recommendations underlining the need for international harmonisation.

MRI in addition to or as a substitute for prostate biopsy: the clinician's point of view.

This paper aims to argue the advantages of using routine multiparametric MRI (mp-MRI) prior to the first series of biopsies in patients with suspected cancer of the prostate indicated by a rise in Prostatic Specific Antigen (PSA). Using biopsy targeted onto a lesion seen by MRI, this diagnostic strategy could increase detection of significant cancers and improve evaluation of their grade and size. This strategy would also mean that the detection of insignificant cancers (microfoci detected by chance during systematic biopsy) would decrease, since if the mp-MRI did not give rise to suspicion, the indications for biopsy would be reduced. It could also reduce the number of biopsies to be performed even when the mp-MRI is suspicious, by resorting solely to targeted biopsies. This review does not evaluate the role of mp-MRI in locoregional staging.

[Renal cell carcinoma of patients younger than 40 years old]. / Le carcinome à cellules rénales du sujet de moins de 40ans.

CONTEXT: Clinical and pathological characteristics of renal cell carcinoma (RCC) of patients younger than 40 years old are not well known. The objective of this study was to analyze these characteristics by comparison to a group of patients aged 58 to 62. METHODS: Retrospective study of a group of patients aged less than 40 years old (group 1, n=44) and a group of patients aged 58 to 62 years old (group 2; n=106) treated surgically for a renal mass from January 2000 to July 2009. A comparative analysis of clinical, pathological characteristics and of cancer-specific survival was performed. Specific survival was calculated with the Kaplan-Meier method and compared with the Log-Rank test. Univariate and multivariable analysis were performed to assess and quantify the effect of age on cancer-specific survival. Covariates were gender, age group, tumor size, pT stage, histological sub-type and Fuhrman grade. RESULTS: Clinical and pathological characteristics were similar in both groups (P>0.05) except for histological sub-type (56% of clear cell RCC for group 1 versus 82% for group 2). In the group of patients younger than 40 years, translocation RCC represented 23% of all RCCs. Cancer-specific survival at five years was similar in both groups (80% and 76% for group 1 and 2 respectively, P>0.58). Fuhrman grade was the only independent prognostic factor of cancer-specific survival (P=0.001). CONCLUSION: Patients younger than 40 years were more likely to have a translocation RCC than their older counterparts for who clear cell RCC represented the main histological sub-type. Cancer-specific survival was similar between both groups. Only a systematic specific immunostaining for TFE3 or TFEB will allow to assess the exact incidence and prognosis of this entity.

[Management of testicular lesions in a population of infertile patients]. / Prise en charge des nodules testiculaires dans une population de patients infertiles.

INTRODUCTION: Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound. METHODS: A retrospective review of all patients treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported. RESULTS: Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign. CONCLUSION: The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe.

[Comparative safety study of two commercialised vaccines against canine babesiosis induced by Babesia canis]. / Etude comparative de l'innocuité de deux vaccins commerciaux contre la babésiose canine provoquée par Babesia canis.

The safety of two vaccines available on the French market against canine babesiosis - Nobivac Piro® (NP) and Pirodog® (P) - have been evaluated. Their local, general and biochemical impacts have been compared in a controlled experimental study. Three groups were used: a control group (T) and two groups vaccinated twice at 21 days interval. All dogs presented moderate local reaction. However, either clinical and biological parameters showed that the NP group presented a significantly more intense reaction at the injection site compared to the P group. No statistical difference has been revealed between the groups P and T evolutions.

Evaluation of the response to an accelerated immunisation schedule using a canarypox-vectored equine influenza vaccine, shortened interdose intervals and vaccination of young foals.

The results of an accelerated immunisation schedule for horses used as part of the emergency response plan to contain and eradicate equine influenza in Australia in 2007 is described. The horses studied were vaccinated with a recombinant canarypox-vectored vaccine (ProteqFlu®, Merial) with a shorter interdose interval. Vaccinated horses included foals aged less than 4 months.

Invasive fungal infections: epidemiology and analysis of antifungal prescriptions in onco-haematology.

WHAT IS KNOWN AND OBJECTIVE: Invasive fungal infections (IFI) are associated with high rates of morbidity and mortality, particularly in onco-haematology patients. We aimed to study the epidemiology of IFI in neutropenic patients and estimate the economic impact of treatment of those infections. METHODS: All patients hospitalized in onco-haematology, and treated with antifungal agents, in 2005 were investigated. Four features were studied: the diagnosis for each patient, the antifungal drugs used, the thoracic densitometry reports and the sero-mycological data. Infectious episodes were stratified according to the EORTC 2008 classification criteria (10). RESULTS AND DISCUSSION: Of the 1130 patients surveyed, 192 patients received systemic antifungal agents. Of these 46% had acute leukaemia, 29% bone-marrow allografts, 7% lymphoma and 18% other malignant haemopathies. Using the EORTC 2008 criteria (10), there were 8 proved IFI (3 aspergillosis, 3 candidosis and 2 other IFI), 17 probable IFI (11 aspergillosis, 6 candidosis) and 16 possible aspergillosis. The incidence of IFI was 2·1%. Eighty patients (41·7%) had received prophylaxis: 56 with fluconazole and 24 with voriconazole. Treatment was most often empirical (n = 127, 66·1%). Combination of two antifungals was used in 17 cases. The mean duration of prophylactic, empirical, proved/probable aspergillosis-directed, candidaemia-directed and combination treatment was 19, 19, 46, 32 and 27 days, respectively. The cost of antifungal treatment in 2005 reached almost 2,000,000 €, including 427,000 € for documented infections (proved and probable), 1,246,000 € for empirical treatment and 58,300 € for prophylaxis. WHAT IS NEW AND CONCLUSION: The incidence of IFI is low but the pharmacoeconomic impact is extremely high. Improved strategies are required to reduce the frequency and duration of empirical treatment without compromising beneficial outcome.