Diaphragmatic weakness related to radiotherapy: 2 cases and a review.

Post-radiation diaphragmatic weakness have rarely been described. We report two cases of post-radiation diaphragmatic weakness from our center, and review the other published cases, computing clinical, electromyography and magnetic resonance imaging data. Including our two cases, seven cases of post-radiation diaphragmatic weakness have been described. Most occurred after mantle-field radiotherapy for Hodgkin lymphoma (5/7), often in associations with chemotherapy (4/7). Other radiations-induced complications were found (5/7) such as brachial plexopathy, cardiac involvement or hypothyroidy. When studied, phrenic nerve conduction studies revealed different profiles, from clearly abnormal responses to limit amplitudes. Imaging can be a useful diagnostic tool, displaying abnormalities with sharp limits matching the radiation field. Data is limited about long-term evolution. Presentation of post-radiation diaphragmatic weakness seems relatively homogeneous. We propose a diagnosis work-up for post-radiation diaphragmatic weakness, to exclude potentially treatable differential diagnoses.

[Skin and mucosal erosions revealing secondary syphilis with otologic and eye disorders]. / Érosions cutanéo-muqueuses révélant une syphilis secondaire avec atteintes otologique et ophtalmologique.

BACKGROUND: The clinical polymorphism of syphilis leads to diagnostic issues. We report a case of secondary syphilis revealed by skin and mucosal erosions, and responsible for sensorineural hearing loss and asymptomatic papillitis. PATIENTS AND METHODS: A 55-year-old man presented oral and peri-anal erosions as the initial symptoms of secondary syphilis. He reported hypoacusis and a pure-tone audiogram revealed bilateral sensorineural hearing loss. Ophthalmological investigation revealed isolated right papillitis and superior temporal scotoma with blind-spot enlargement. TPHA-VDRL serology was strongly positive for plasma (TPHA 1/10,240 and VDRL 1/64) but doubtful for cerebrospinal fluid. For his hearing and eye disorders, considered as related to neurosyphilis, the patient received a 14-day course of intravenous penicillin G, associated with systemic corticosteroids with gradual reduction over a period of fifteen weeks. The patient's skin and mucosal erosions resolved, as did his papillitis. His hearing loss remained stable. Serological monitoring at three months showed a sixteen-fold decrease in VDRL titre. DISCUSSION: The re-emergence of syphilis has led to increasing incidence of related ophthalmological and otological disorders. This report highlights the first-line role of the dermatologist in systematic diagnosis and in screening for associated involvement.

X-ray powder diffraction in reflection geometry on multi-beam kJ-type laser facilities.

An ultrafast x-ray powder diffraction setup for laser-driven dynamic compression has been developed at the LULI2000 laser facility. X-ray diffraction is performed in reflection geometry from a quasi-monochromatic laser-generated plasma x-ray source. In comparison to a transmission geometry setup, this configuration allows us to probe only a small portion of the compressed sample, as well as to shield the detectors against the x-rays generated by the laser-plasma interaction on the front side of the target. Thus, this new platform facilitates probing of spatially and temporarily uniform thermodynamic conditions and enables us to study samples of a large range of atomic numbers, thicknesses, and compression dynamics. As a proof-of-concept, we report direct structural measurements of the bcc-hcp transition both in shock and ramp-compressed polycrystalline iron with diffraction signals recorded between 2θ ∼ 30° and ∼150°. In parallel, the pressure and temperature history of probed samples is measured by rear-side visible diagnostics (velocimetry and pyrometry).