Automation in radiotherapy treatment planning: Examples of use in clinical practice and future trends for a complete automated workflow.

Modern radiotherapy treatment planning is a complex and time-consuming process that requires the skills of experienced users to obtain quality plans. Since the early 2000s, the automation of this planning process has become an important research topic in radiotherapy. Today, the first commercial automated treatment planning solutions are available and implemented in a growing number of clinical radiotherapy departments. It should be noted that these various commercial solutions are based on very different methods, implying a daily practice that varies from one center to another. It is likely that this change in planning practices is still in its infancy. Indeed, the rise of artificial intelligence methods, based in particular on deep learning, has recently revived research interest in this subject. The numerous articles currently being published announce a lasting and profound transformation of radiotherapy planning practices in the years to come. From this perspective, an evolution of initial training for clinical teams and the drafting of new quality assurance recommendations is desirable.

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital.

OBJECTIVES: In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. METHODS: All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. RESULTS: In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. CONCLUSIONS: Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

[Etiological diagnosis of pulmonary hypertension: A cause of difficult diagnosis]. / Diagnostic étiologique de l'hypertension pulmonaire : une cause de diagnostic difficile.

INTRODUCTION: Schistosomiasis associated pulmonary arterial hypertension belongs to group 1 of the pulmonary hypertension classification and should be considered in any patient with pulmonary hypertension returning from an endemic area. CASE REPORT: A 17-year-old patient was hospitalized for pulmonary hypertension detected during the initial assessment of viral hepatitis B-related cirrhosis with portal hypertension. The initial assessment established the diagnosis of pulmonary hypertension secondary to viral hepatitis B-cirrhosis. The patient's hepatic and haemodynamic condition deteriorated and he was treated with intravenous epoprostenol. This allowed subsequent performance of a liver transplantation. Epoprostenol could then be discontinued. Unexpectedly, histology of the liver explant revealed florid schistosomiasis in addition to hepatitis B cirrhosis. CONCLUSION: The diagnosis of pulmonary arterial hypertension associated with schistosomiasis may be difficult. It is necessary to repeat the serological studies and, sometimes, to obtain a rectal biopsy. The treatment of pulmonary arterial hypertension associated with schistosomiasis is based on specific therapies and antiparasitic treatment.

Double pigtail ureteral stent in pediatric urology.

We used a double pigtail ureteral stent in 16 children (aged 15 days to 13 years). Indications included: pyeloplasty (12 cases with 2 anastomotic leakages and 1 acute post-operative renal retention), renal trauma (1 case), difficult ureterocystoneostomy (1 case), urinary ascites (1 case), and abdominal tumor compression (1 case). This drainage procedure provides a useful alternative to an external tube diversion (standard ureteral stent or nephrostomy). In pediatric urology, the double stent offers the advantages of exceptional patient tolerance, drainage security and efficiency, and short hospital stay. In our experience, stents were removed on an out-patient basis under general anesthesia but non-endoscopic removal will be possible when smaller magnetic retrievers become available in the urologic armamentarium.

[Internal urinary drainage by double J stent in pediatric urology]. / Le drainage urinaire interne par sonde double J en urologie pédiatrique.

We used double pigtail ureteral stent in 16 children (aged 15 days to 13 years old). Indications included: pyeloplasty (12 cases with 2 anastomotic leakages and 1 acute postoperative renal retention), renal trauma (1 case), difficult ureterocystoneostomy (1 case), urinary ascites (1 case), and abdominal tumor compression (1 case). This drainage procedure provides a useful alternative to an external tube diversion (standard ureteral stent or nephrostomy). In pediatric urology, the double pigtail stent offers the advantages of exceptional patient tolerance, drainage security and efficiency, and short hospital stay. In our experience, stents were removed in an outpatient basis under general anesthesia but non endoscopic removal will be possible when smaller magnetic retrievers become available in urologic armamentarium.

[A rare psychogenic anejaculation. Report of a case of prolactin adenoma]. / Une étrange anéjaculation psychogène. A propos d'un cas d'adénome à prolactine.

The authors report a case of prolactinoma discovered during assessment of a case of ejaculation failure attributed for more than eight years to a psychogenic cause. Because of the size of the tumour, surgical resection of the lesion left a persistent hyperprolactinaemia, which only returned to normal after treatment with bromocriptine. The persistence of sexual disorders justified adjuvant treatment with exogenous testosterone. Despite the unusual mode of presentation of hyperprolactinaemia, these data correspond to those reported in the literature. Prolactin assay should therefore be performed in any case of male sexual dysfunction to allow the early diagnosis of prolactinoma and to improve the functional prognosis.

[Isolated urethral injury following coital faux pas. Report of a case with no associated injury of the corpora cavernosa]. / L'atteinte uréthrale isolée dans les faux pas du coït. A propos d'un cas sans lésion associée des corps caverneux.

An urethral lesion due to coital faux pas is usually associated with a lesion of the corpora cavernosa, but may occasionally be isolated. Suspected clinically due to the presence of urethral bleeding, the diagnosis of ruptured urethra is based on urethrography and, more importantly, urethroscopy, which appears to be more reliable for defining the complete or partial nature and the site of the rupture. Even in incomplete forms, surgical suture of the lesion appears to give better results than urinary diversion alone.

[Posterior epispadias with unknown complete duplicated urethra]. / Epispadias postérieur avec duplicité uréthrale complète méconnue.

The authors report a case of posterior epispadias associated with complete ventral urethra only discovered during the urethroplasty phase of the operation. This malformation is a rare form of urethral duplication and should be considered in any case of apparently isolated posterior epispadias.

Renal oncocytoma in a child.

Oncocytoma is an exceptionally rare renal tumor in children. We report on one case of a twelve-year-old girl treated by nephrectomy.

[Carpal tunnel syndrome in children. Apropos of 4 personal cases]. / Le syndrome du canal carpien chez l'enfant. A propos de 4 observations personnelles.

Four cases of Carpal Tunnel syndrome during childhood are reported. Two of them are post traumatic cases; for one child, the syndrome was caused by hypertrophic cal six months after trauma. The other child has been operated because of a median and ulnar nerve deficit syndrome, which appeared one month after fracture. In the third observation, the authors have seen an abnormal muscle just in front of annular anterior ligament of the carpus during surgery. This muscle was assimilated to hypertrophic Palmaris Brevis muscle. In the last observation, the adolescent had a Poland syndrome with Sprengel malformation. In this paper, the authors point out clinical particularities due to musculo-tendinous malformation which can lead to Carpal Tunnel syndrome.

[Hellp syndrome may precede the appearance of arterial hypertension in pregnancy toxemia]. / Le "Hellp syndrom" peut précéder l'apparition de l'hypertension artérielle au cours de la toxémie gravidique.

The "Hellp syndrome" describes the association of three biological abnormalities (hemolysis, liver abnormalities and thrombocytopenia) establishing the severity of arterial hypertension during pregnancy and requiring the interruption of pregnancy as much for the child as for the mother. This article reports a case of "Hellp syndrome" which was special in that the biological abnormalities preceded the occurrence of pre-eclampsia. The signs, diagnosis, prognosis and treatment of the "Hellp syndrome" are studied in this article.