Feasibility study combining low dose rate (192)Ir brachytherapy and external beam radiotherapy aiming at delivering 80-85 Gy to prostatic adenocarcinoma.

BACKGROUND: Increasing the radiation dose to prostatic adenocarcinoma has provided higher local control rates. A total of 80 Gy seem necessary to achieve this goal but patient set-up and prostate motion remain difficult problems to solve in conformal radiotherapy. Brachytherapy which overcomes these points could be an alternative way to external beam boost fields. We wanted to transpose the irradiation models largely used in cervix cancer treatment combining external beam radiotherapy and low dose rate brachytherapy. MATERIALS AND METHODS: In 71 patients with 19.5 and 13 ng/ml mean and median PSA levels, respectively, a dose escalation from 74 to 85 Gy was performed in four groups. RESULTS: Shifting from intraoperative placement of sources vectors (Group I) to positioning under ultrasound controls (groups II-IV), improving the implantation shape and optimizing radiation delivery to urethral bed have reduced the total dose to rectal wall under 65 Gy and to urethra under 100 Gy. Rectal/prostate dose ratio was lowered from 0.7 (Groups I-II) to 0.58 (Groups III-IV) while avoiding problems resulting from pelvic bone arch interference, prostate volume or seminal vesicles location. The mean and median follow-up periods are 28 and 18 months. In Groups III and IV 85% of patients without hormonotherapy treated with 80-85 Gy normalized PSA under 1 ng/ml within 6 months. No severe late effect has been noted for patients implanted under echographic control. CONCLUSIONS: The method described allows to deliver 85 Gy. Longer follow-up is however needed but the levels of dose delivered are not expected to induce prohibitive side effects.

[Reiter syndrome: apropos of a case]. / Le syndrome de Reiter: à propos d'un cas.

We report the case of a 25 year-old man presenting Reiter's syndrome (urethritis, conjunctivitis and oligoarthritis). This clinical triad is a particular expression of reactive arthritis. A genital or enteric infection can be responsible for the onset. Presence of HLA B27 histocompatibility antigen is a genetic factor favoring the development of Reiter's syndrome. Many organs or systems can be affected. In addition to eradication of the initiating infection, treatment is mainly symptomatic and management is multidisciplinary.

[Liposarcoma of the spermatic cord]. / A propos d'un cas de liposarcome du cordon spermatique.

The liposarcoma is mainly located in the retroperitoneum and rarely involves the spermatic cord. Dissemination occurs more often via haematogenous way than by lymphatic way. The incidence of local recurrence is higher than distant metastases. The treatment of choice is the wide excision. Adjuvant radiotherapy is recommended in the well differentiated and myxoid type of tumors if the local control during excision is not complete or wide enough. Benefit of chemotherapy is still controversial and limited. Case report of a stage 1 liposarcoma of the spermatic cord, four years after excision of a large lipoma during a hernia repair. The treatment consisted in radical excision of this liposarcoma without any adjuvant therapy. Follow-up of 30 months without recurrence.

Treatment of glans hyperemia after penile revascularization by transcatheter embolization.

Glans hyperemia after penile revascularization is a well known complication normally treated by surgery. However, this reintervention is often difficult due to local fibrosis. We report a case of successful embolization after supra-selective catheterization of the deep dorsal vein through the surgical anastomosis.

[Aneurysm of the renal artery and its infarct complications (clinical case and literature review)]. / Anévrisme de l'artère rénale et ses complications d'infarctus (cas clinique et revue de littérature).

The authors are reporting the case of a 74 year old man, presenting a renal artery aneurysm. Regarding clinical aspects, medical treatment was elected. The most frequent cause of renal infarct is embolisation arising from the heart, followed by large vessels emboli that are more exceptional. Embolisation arising from the renal artery aneurysms is not very common. Unless contra-indications, surgical cure of the aneurysm is necessary, except those that are non complicated, with a diameter of less than 1.5 cm.