Revolutionizing localized prostate cancer treatment: Stereotactic radiotherapy "Moroccan experience".

INTRODUCTION: Prostate cancer is the most common urological cancer, and its incidence  is increasing. Radical prostatectomy and radiotherapy are theprimary treatments for localized forms. Stereotactic Body RadioTherapy (SBRT), a new and innovative therapy, has been validated for some cancer localizations but not yet for localized prostate cancer. Our study aims to report the efficacy and tolerance results of SBRT for localized prostate cancer. MATERIALS AND METHODS: This is a retrospective study of 27 patients with localized prostate cancer (CaP) who were treated with SBRT in our department from 2017 to 2021 using transponders for tumor tracking. The dose was 36.25 Gy delivered in five fractions of 7.25 Gy. The delineation and doses of organs at risk were determined based on the recommendations of the SFRO and the TG101 report of medical physics. All patients were treated using a latest-generation linear accelerator (True Beam STXÒ). RESULTS: Acute toxicities were observed in 33.3% of cases, with 22.2% grade 1 or 2 genitourinary (GU) and no grade 3 while 11.1% gastrointestinal (GI) toxicities were reported as grade 1-2 (7.4%) and one case grade 3 (3.7%). Late grade 1 or 2 GU toxicity was observed in 14.84% of cases, with no reports of late GI toxicity. After a 26-month follow-up period, the biochemical failure-free survival rate was 92.6%. CONCLUSIONS: The results of our study are consistent with the existing literature and support the safety and effectiveness of SBRT as a treatment option for localized prostate cancer (CaP). In the United States, both ASTRO and the NCCN recognize SBRT as a valid treatment option for localized CaP. Ongoing phase III trials are being conducted to further substantiate these long-term results and to establish SBRT as the future standard of care for localized CaP.

An unusual intracardiac image.

One of the most serious complications in cardiovascular surgery is the unintentional deposit of material and surgical instruments. Very few articles portray these complications in children. This is not the case with regard to interventional and surgical cardiovascular procedures in adults. We report a case concerning a cystic heart image related to a cardiac iatrogenic foreign body in a girl of 14 years. She has been operated 13 years ago for patent ductus arteriosus and aortic stenosis and currently she is admitted for a cyanosis and a dyspnoea.

Recurrent febrile respiratory distress in infant: which diagnosis?

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare congenital anomaly. CCAM diagnosis can be made by prenatal ultrasound or in postnatal cases with regard to respiratory distress or recurrent respiratory infections. We present, for diagnostic purposes, a case of a patient, aged 4 months who had suffered since birth from recurrent bronchopulmonary infections. He was hospitalised several times for febrile respiratory distress. Chest x-rays previously performed were interpreted as normal. A final radiograph indicated the diagnosis and it was confirmed by CT. Surgical resection was performed with a positive result. CCAM responds to the prenatal diagnosis and requires frequent ultrasound checks during pregnancy and allowing for optimal management. The radiological assessment leads to the diagnosis and addresses the treatment which is based on a surgical cure.

Longitudinal evaluation of the hypothalamic-pituitary-testicular function in 8 boys with adrenal hypoplasia congenita (AHC) due to NR0B1 mutations.

BACKGROUND: Boys carrying mutations in the NR0B1 gene develop adrenal hypoplasia congenita (AHC) and impaired sexual development due to the combination of hypogonadotropic hypogonadism (HH) and primary defects in spermatogenesis. METHODS: We analysed the evolution of hypothalamic-pituitary-testicular function of 8 boys with AHC due to NR0B1 mutations. Our objective was to characterize and monitor the progressive deterioration of this function. RESULTS: The first symptoms appeared in the neonatal period (n = 5) or between 6 months and 8.7 years (n = 3). Basal plasma adrenocorticotrophic hormone (ACTH) concentrations increased in all boys, whilst cortisol levels decreased in one case. The natremia was equal or below 134 mmol/L and kaliemia was over 5 mmol/L. All had increased plasma renin. In 3 of 4 patients diagnosed in the neonatal period and evaluated during the first year, the basal plasma gonadotropins concentrations, and their response to gonadotropin releasing hormone (GnRH) test (n = 2), and those of testosterone were normal. The plasma inhibin B levels were normal in the first year of life. With the exception of two cases these concentrations decreased to below the normal for age. Anti-Müllerian hormone concentrations were normal for age in all except one case, which had low concentrations before the initiation of testosterone treatment. In 3 of the 8 cases the gene was deleted and the remaining 5 cases carried frameshift mutations that are predicted to introduce a downstream nonsense mutation resulting in a truncated protein. CONCLUSIONS: The decreases in testosterone and inhibin B levels indicated a progressive loss of testicular function in boys carrying NR0B1 mutations. These non-invasive examinations can help to estimate the age of the testicular degradation and cryopreservation of semen may be considered in these cases as investigational procedure with the aim of restoring fertility.

Tuberculosis of the renal artery: a rare cause of renovascular arterial hypertension.

Tuberculosis is an endemic disease in Morocco. Main blood vessels are rarely affected; the few mentioned cases are aneurysmal. We report a 17-year-old patient presenting with renovascular arterial hypertension, revealed thanks to the discovery of an occlusion of the right renal artery in Duplex scan. During the intervention, the observation of pararenal and mesenteric tuberculous polyadenopathy let us suggest the same kind of lesion at the level of the occluded renal artery. Once antituberculosis treatment had been carried out, the right renal artery was revascularized with a right iliorenal bypass using reversed internal saphenous vein. The postoperative course was uneventful, with an 18-month follow-up. Arterial pressure was normal without antihypertensive treatment, and the bypass was patent. As far as we know, this is the first case of renovascular arterial hypertension resulting from tuberculosis treated with an iliorenal bypass.

Extracranial carotid aneurysm in Behçet disease: Report of two new cases.

Extracranial carotid aneurysm due to Behçet disease is extremely rare. To our knowledge, this complication has been previously reported in only 12 cases. We report two new cases of extracranial carotid aneurysm in Behçet disease and discuss the clinical features, therapeutic modalities, and postoperative complications of these uncommon lesions.

Endovascular repair of abdominal aortic aneurysms with a unibody stent-graft: 3-year results of the French Powerlink Multicenter Trial.

PURPOSE: To report the results of a prospective multicenter study on endovascular repair of abdominal aortic aneurysms (AAA) using the bifurcated Powerlink stent-graft. METHODS: Between June 2000 and July 2001, endovascular AAA repair using the bifurcated Powerlink stent-graft was performed at 14 centers on 64 patients (61 men; mean age 70 years, range 56-90) fit for open repair. All procedures were attended by a proctor. Data were collected prospectively, and surveillance computed tomograms were reviewed by an independent center. RESULTS: Technical success was achieved in all cases. There was no postoperative death. During a minimum 3-year follow-up (mean 40.6 months, range 1-51), there were 3 (4.7%) stent-graft migrations associated with type I endoleaks. Two (3.1%) of these patients were converted to open repair, and 1 had a proximal extension implanted. No aneurysm rupture occurred, and no stent-graft degradation was observed. Six (9.4%) patients had secondary endoleak (3 type I and 3 type II). The limb occlusion rate was 3.1%. Six (9.4%) patients had secondary procedures. At 3 years, 58 (91.0%) patients were available for follow-up (4 deaths, the 2 conversions). There was a significant decrease between preoperative and 3-year mean AAA diameter (54.6+/-7 versus 47.6+/-10 mm, respectively; p<0.001). Aneurysm sac shrinkage was observed in 32 (55.2%) patients. Twenty-five (43.1%) patients had a stable aneurysm sac diameter. CONCLUSIONS: Endovascular repair using the bifurcated Powerlink stent-graft is safe and effective. Unibody design seems to confer advantages in terms of durability. These results need to be confirmed by longer follow-up and larger series.