[Impact of partial nephrectomy in a hybrid operating room on the activity of kidney cancer surgery]. / Évaluation de l'utilisation de la salle hybride sur l'activité de chirurgie en cancérologie rénale.

INTRODUCTION: Partial nephrectomy (NP) after embolization of tumor vessels (NPESH) in a hybrid room combines embolization of tumor vessels and enucleation of the tumor under laparoscopy in the same operative time. The purpose of this study was to assess the impact of the use of NPESH in the management of patients treated with surgery for a localized kidney tumor. MATERIAL AND METHODS: Using the uroCCR database, we included all consecutive patients operated in a university hospital for localized kidney tumor. From 2011 to May 2015, patients were treated by Standard Partial Nephrectomy (NPS) Laparoscopic or Open and from May 2015 to May 2019 by NPESH. We evaluated characteristics of patients, tumors, perioperative data and complications. These data were compared by Student and Khi2 tests. RESULTS: 87 NPS were performed during Period 1 and 137 NPS were performed during period 2. The ASA score of patients undergoing NPESH was higher than NPS (P<0.0001). The tumor complexity and median tumor size were similar in the two groups (P=0.852 and P=0.48). The complication rate for NPS and NPESH was 55.2% and 33.6% (P=0.002). There were less severe complications in the NEPSH group (P=0.012). The median length of stay was 8 and 4 days for the NPS and NPESH groups (P<0.0001). Positive surgical margins were 2 (2.3%) and 6 (4.6%) for the NPS and NPESH group (P=0.713). DISCUSSION: NPESH is an efficient technique compared to NPS. It seems to be an interesting alternative to limit renal ischemia, complication rate and length of stay for the management of localized kidney tumors.

PLASMATIC LEVELS OF NEUROPEPTIDES, INCLUDING OXYTOCIN, IN CHILDREN WITH AUTISM SPECTRUM DISORDER, CORRELATE WITH THE DISORDER SEVERITY.

CONTEXT: Oxytocin has been investigated as a potential medication for psychiatric disorders. OBJECTIVE AND DESIGN: This study prospectively investigates correlations between oxytocin and other neuropeptides plasma levels in patients with autism spectrum disorders (ASD) according to severity and treatment, as compared to controls. SUBJECTS AND METHODS: Thirty-one children (6 neurotypical as control) participated in this study. The patients were classified into mildly and severely-affected, according to Autism Diagnostic Observation Schedule (ADOS) scores. Oxytocin, orexin A and B, α-MSH, ß-endorphins, neurotensin and substance P were investigated using a quantitative multiplex assay or a competitive-ELISA method. RESULTS: Plasma oxytocin levels differed between the groups (F (2, 24) =6.48, p=0.006, η2=0.35, observed power=86%): patients with the mild ASD had higher values of plasma oxytocin than those with the severe form (average difference=74.56±20.74pg/mL, p=0.004). CONCLUSIONS: These results show a negative correlation between plasma levels of oxytocin and the severity of ASD and support the involvement of oxytocinergic mechanisms in ASD.

Burned bodies: post-mortem computed tomography, an essential tool for modern forensic medicine.

Currently, post-mortem computed tomography (PMCT) has become an accessible and contemporary tool for forensic investigations. In the case of burn victims, it provides specific semiologies requiring a prudent understanding to differentiate between the normal post-mortem changes from heat-related changes. The aim of this pictorial essay is to provide to the radiologist the keys to establish complete and focused reports in cases of PMCT of burn victims. Thus, the radiologist must discern all the contextual divergences with the forensic history, and must be able to report all the relevant elements to answer to the forensic pathologist the following questions: Are there tomographic features that could help to identify the victim? Is there evidence of remains of biological fluids in liquid form available for toxicological analysis and DNA sampling? Is there another obvious cause of death than heat-related lesions, especially metallic foreign bodies of ballistic origin? Finally, what are the characteristic burn-related injuries seen on the corpse that should be sought during the autopsy? TEACHING POINTS: • CT is highly useful to find features permitting the identification of a severely burned body. • PMCT is a major asset in gunshot injuries to depict ballistic foreign bodies in the burned cadavers. • CT is able to recognise accessible blood for tests versus heat clot (air-crescent sign). • Heat-related fractures are easily differentiated from traumatic fractures. • Epidural collections with a subdural appearance are typical heat-related head lesions.

Evaluation of unenhanced post-mortem computed tomography to detect chest injuries in violent death.

PURPOSE: The aim of this study was to assess the performances of unenhanced post-mortem computed tomography (CT) to detect thoracic injuries in violent death. MATERIALS AND METHODS: Retrospectively, we conducted a review of unenhanced CT scans of 67 victims of violent deaths with thoracic injuries and compared CT findings with the results of clinical autopsy. Our gold standard was a comparison of CT scans with autopsy discussed in a monthly forensic radiology multidisciplinary team meeting (MDTM). The data were collected by organ system: heart, pericardium, aorta, lungs, pleura, bone, and diaphragm and performance indices (sensitivity, specificity, accuracy) were calculated. RESULTS: Pleural (59/67) and bone (55/67) injuries detected on CT were also found at autopsy and confirmed by the MDTM (sensitivity and specificity 100%). Seventeen out of 67 diaphragmatic lesions were visible on CT. Eighteen out of 67 were confirmed during MDTM after autopsy, yielding overall sensitivity of 94% and specificity of 98%. Forty out of 67 lung contusions were found on CT with two false positives and one false negative yielding 95% sensitivity for CT with a specificity of 96%, and accuracy of 95%. Fourteen out of 67 aortic injuries were found on CT compared to 19 confirmed during MDTM (sensitivity 74%, specificity 85%, accuracy 82%). In terms of pericardial lesions, 19/67 were found on CT and 20 on autopsy and confirmed during MDTM (sensitivity 80%, specificity 94%, accuracy 85%). Ten out of 10/67 cardiac lesions were visible on CT imaging and 15 found on autopsy and confirmed during MDTM (sensitivity 57%, specificity 94%, accuracy 81%). CONCLUSION: Unenhanced post-mortem CT performs well to detect pleural, pulmonary, bone and diaphragmatic injuries but less well to identify cardiac and aortic injuries, for which the use of indirect signs is essential.

Simultaneous CT angiography and whole-body CT is an effective imaging approach before multiorgan retrieval.

PURPOSE: To assess the role of whole-body computed tomography (CT) for determining morphological suitability before multiorgan retrieval (MOR) in brain dead patients. MATERIALS AND METHODS: Fifty-one clinically brain dead patients (21 women, 30 men; mean age 61 year±15) were included in this prospective, single center study. All patients had CT angiography of the brain and whole-body CT examination. CT images were evaluated for the presence of morphological abnormalities of lungs, liver and other abdominal organs and presence of vascular anatomical variants. The results of CT examinations were compared to intraoperative findings observed during organ harvesting and/or the results of histopathological analysis of biopsy specimens. The impact of whole-body CT examination on the harvesting process was evaluated. RESULTS: Ninety-five percent of vascular anatomical variants that were found intraoperatively were depicted on CT. CT density measurements predicted surgical finding of steatosis in 80% of patients. Whole-body CT changed the MOR strategy in 21/51 patients (41%) including 3 MOR cancellations and 8 grafts refusals, whereas organ harvesting was continued in 10 patients after histopathological analysis was performed. CONCLUSION: Selection of potential graft donors using whole-body CT is reliable and improves graft selection during MOR.

Imaging of thoracic aortic injury.

Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life threatening. It needs to be diagnosed rapidly but diagnostic pitfalls must be avoided. CT angiography is the standard examination. The main CT signs of rupture or disruption of the thoracic aorta are periaortic hematoma, intimal flap, pseudo-aneurysm and contrast agent extravasation. There are three types of lesion: intimal, subadventitial or pseudo-aneurysmal, and complete rupture with lesion of the three tunicae, and it is important to grade them for better therapeutic management. The main diagnostic pitfalls of the CT scan are the presence of a ductus diverticulum and post-isthmic fusiform dilatation. Associated lesions must not be overlooked. The most common are ruptures of the aortic root and the thoracic aorta in the diaphragmatic hiatus.

Bone-patch type secondary projectiles: A report on two shots fired at point-blank range using hollow point bullets.

The number of head wounds due to firearms remains low in France because these cases are primarily linked to suicide (or attempted suicide) and, to a lesser extent, to attacks or hunting accidents [1]. Characterized by the impact of a projectile, which in most cases is made of metal, at high levels of kinetic energy, such acts generally result in severe trans-cerebral lesions with significant levels of morbidity/mortality [2]. Seldom are cases reported in the literature that give a detailed study of intracranial foreign bodies made of bone in such situations [3]. Here we report on the case of two suicides resulting from a transcranial gunshot wounds caused by weapons and ammunition issued by the French police force. Each case helped distinguish a characteristic bone fragment, in the form of a "patch", equivalent in size to the caliber of the bullet.

Post-treatment MRI aspects of photodynamic therapy for prostate cancer.

OBJECTIVES: Photodynamic therapy is a new focal therapy for prostate cancer. METHODS: In this technique, a photosensitising agent is introduced intravenously, then activated by local laser illumination to induce tumour necrosis. Treatment efficacy is assessed by magnetic resonance imaging (MRI). RESULTS AND CONCLUSIONS: We illustrate specific post-treatment MRI aspects at early and late follow-up with pathological correlations. TEACHING POINTS: • Dynamic phototherapy is a new and promising focal therapy for prostate cancer. • One-week MRI shows increased volume of the treated lobe and large, homogeneous necrosis area. • Six-month MRI shows significant changes of the prostate shape and signal. • Six-month MRI becomes "base line" appearance for further follow-up or monitoring.

Applications of phase-contrast velocimetry sequences in cardiovascular imaging.

AIMS: To describe and illustrate the main applications of phase-contrast flow quantification in cardiovascular imaging. CONCLUSION: Phase-contrast velocimetry sequences provide an accurate, reliable, reproducible and non-invasive study of blood flow, information which is sometimes not available from other investigation methods. The haemodynamic information obtained from these complement MRI angiography images. They appear to have a range of clinical applications, firstly improving pathophysiological understanding but also contributing to the treatment and follow-up strategy after surgical or endovascular treatment.

[Dose reduction during CT coronary angiography]. / La réduction de dose en coroscanographie.

Dose delivery during CT coronary angiography with retrospective ECG gating is high especially due to the important slice overlapping. Optimization of the acquisition parameters is necessary to reduce patient exposure. First, the height of the scan field should be limited to the heart. Both kV and mA should be adjusted based on patient morphology. ECG gated exposure modulation with mA reduction during systole, a technique most applicable for patients with slow and regular heart rate, can result in a dose reduction up to 50%. The use of prospective ECG gating can also reduce patient dose. This technique also requires patients with slow and regular heart rate.

[Cystic and cavitary lesions of the lung: imaging characteristics and differential diagnosis]. / Kystes et cavités du poumon: description sémiologique et approche étiologique.

Gas containing lesions of the lung can be differentiated into cystic and cavitary lesions based on their imaging characteristics, which is helpful for differential diagnosis. The imaging features include number, size, thickness and smoothness of the walls, content, lesion distribution and occasional associated lesions. Some imaging features have characteristic diagnostic implications: mural nodule and meniscus sign. Cysts are characterized by thin and regular walls, less than 2 mm in thickness. The differential diagnosis includes: histiocytosis X, lymphangioleiomyomatosis, cystic metastases, septic emboli, pulmonary sequestration. Emphysema, honeycombing and cystic bronchiectases should also be considered. Cavitary lesion have thicker walls. The most frequent etiologies include abscess, cavitary tumors, mycobacterial infections and fungal infections.

[Persistent sciatic artery: possible false negative imaging]. / Artère sciatique persistante: possibles faux-négatifs de l'imagerie.

Persistent sciatic artery is a rare congenital malformation due to the lack of regression of the dorsal arterial axis of the embryo that can be revealed by serious complications. We report a case of bilateral persistent sciatic artery revealed by subacute distal ischemia. This case illustrates the possibility of false negative imaging and the importance of ruling out this diagnosis in case of recurrent and apparently idiopathic distal embolism.

Experimental study of antibiotic-induced immunosuppression in mice. II. Th, Ts and NC cell involvement.

In penicillin(pen), streptomycin(str), kanamycin(kan) and tetracycline(tet)-treated CBA/J adult mice, no difference was noticed as concerned spleen T "helper" (Th) cell activity, as studied by means of response to PHA of X-irradiated/whole T fraction cell mixtures in vitro. On the contrary, in erythromycin(erm), colistin(col) and chloramphenicol(chl)-treated groups, Th cell activity was significantly decreased. On the other hand, spleen T "suppressor" (Ts) cell activity (assayed by response to PHA of mixtures containing pre-incubated with Concanavalin A and whole T cells, respectively) was augmented in samples arising from chl-treated group. These results are also supported by experiments testing Th or Ts soluble factors, induced in spleen T cells belonging to each antibiotic-treated group and purified by affinity chromatography (Concanavalin A-Sepharose 4B columns). Thus, it was confirmed both Th cell deficiency in erm, col or chl-groups, and Ts cell augmentation in chl-group. As regards spleen "natural cytotoxic" (NC) cell activity, as tested in a xenogeneic "target" cell substrate, a diminished cytotoxic capacity manifested chl-group-derived NC cells, possibly by richness in own "non-specific suppressor" (NSS) cells. NC cell samples in vitro supplemented with NSS cells arising from suckling mouse spleens and a lower cytotoxic activity, in a larger extent in chl-group-derived NC cells, as compared to other groups. The pre-incubation of control-group-NC cells with several antibiotic preparations in vitro was followed by decrease of the cytotoxic values in erm, col and chl-samples, suggesting a drug-induced NC receptor "masking", that prevented "target" cell recognition in mice--II. In the case of NSS addition in vitro, as strong inhibition of the cytotoximity occurred in chl-treated NC cells derived from the control group, that proves a possible chloramphenicol-induced immunodepression by potentiation of NSS inhibitory effect on NC cells. Based upon data from the present work, as well as from the previous work, the authors suggest a classification of several mechanisms by which the antibacterial antibiotics can act as immunosuppressive.