Narrative review of PET/CT performances at biochemical recurrence in prostate cancer after radical prostatectomy and impact on patient disease management: Revue narrative à propos des performances de la TEP/TDM en cas de récidive biochimique après prostatectomie radicale dans le cancer de la prostate et impact sur la prise en charge des patients.

Patients treated by radical prostatectomy (RP) for localized prostate cancer (PCa) may experience biochemical recurrence (BCR) in approximately 30% of cases. Recently, advances in imaging modalities and in particular Positron-Emission Tomography with computed tomography (PET/CT) imaging allow for better detection and characterization of lesions outside the prostatic bed at recurrence. Thus, treatment at BCR can be significantly improved by a tailored strategy based on new generation imaging. A more precise and accurate staging of the disease at recurrence paves the way to more appropriate treatment, potentially translating into better survival outcomes of these patients. This review therefore highlights the interest of PET/CT at the time of BCR, its superiority over standard imaging in terms of staging, and its impact on guiding the different therapeutic possibilities depending on the site, number, and volumes of recurrence. Indeed, we will discuss below about different strategies and their indications: salvage radiotherapy of the prostate bed, systemic therapies, stereotactic body radiotherapy and others therapeutical strategies. The various innovative approaches based on PET/CT implementation are partly underway within protocol trials to prove their benefits on clinically meaningful endpoints. © 2022 Elsevier Masson SAS. All rights reserved.

Magnetic resonance imaging of von Meyenburg complexes: report of a pathologically documented case.

Von Meyenburg complexes (VMC) are rare malformations of the bile ducts. They are usually associated with adult dominant polycystic disease (ADPCD). Although generally benign, they may give rise to cholangiocarcinomas. Herein, we report the third MR documented case of VMC. The comparative diagnostic value of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) examinations is discussed.

Liver ischemia for hepatic resection: where is the limit?

BACKGROUND: A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported. METHODS: Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients). RESULTS: No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.

Macrophage activation syndromes.

The clinical and laboratory features of 47 cases of macrophage activation syndrome (MAS) were reviewed in a workshop within the Groupe Français d'Hématologie cellulaire. There was no predilection for a particular age group, while common symptoms at presentation included fever, hepatic and splenic enlargement and profound depression of blood count. Examination of bone marrow aspirates allowed diagnosis to be established in almost all cases. The most characteristic sign of MAS was the presence of well differentiated macrophages without notable cytologic abnormalities but shown to be actively ingesting haematopoietic elements. Haemophagocytic syndromes generally occur in patients who develop infections in the context of preexisting immunologic abnormalities or neoplasms. In the majority of patients evolution of the disease was regressive, once spontaneously but often after antibiotic, antiparasitic and/or antiviral treatment accompanied or not by corticotherapy and/or chemotherapy. Some regressive phases were followed by more or less long term relapse, especially in the case of associated systemic lupus erythematosus. There exists at present no explanation for the occurrence of MAS, although one may remark its association with other pathologies, in particular congenital or acquired immune deficiencies and haemopathies. Several hypotheses have been proposed to explain the appearance and evolution of the disease and at present two pathways of investigation of MAS seen to merit attention: exploration of macrophages themselves and their secretion products and exploration of lymphocytes and NK cells. The current possibilities for these investigations should lead to a greater understanding of the physiopathology of MAS and it is to be hoped that a better application of appropriate therapy will enable control of its evolution.

[Is ischemia of the liver, lasting longer than an hour, a severity factor in hepatectomies? Apropos of 19 cases]. / L'ischémie du foie de plus d'une heure est-elle un facteur de gravité des hépatectomies? A propos de 19 cas.

Nineteen hepatic resections with continuous liver ischemia exceeding one hour (60 to 85 min, m = 68 +/- 8 min) are reported. Surgery was undertaken for 15 malignant tumors, mainly metastatic, and 4 benign tumors. In 16 out of 19 cases, a major hepatic resection was necessary to remove massive and central lesions. Vascular clamping was a Pringle maneuver (9 cases), associated with inferior vena cava clamping-complete hepatic vascular exclusion (10 cases). 2050 +/- 2000 ml of packed red cells were infused peroperatively. No operative nor hospital mortality was recorded. Major complications developed in 6 patients: 3 intraperitoneal haemorrhages leading to complementary hemostasis of the raw surface of the liver in the first 24 hours, 1 erosive gastritis, 2 subphrenic abscesses treated by percutaneous drainage. Severe liver failure developed after left trisegmentectomy on a steatotic liver and led to emergency transplantation on the 17th day with success. Except this case, biochemical liver tests demonstrated slight and transitory alteration. Magnetic resonance imaging confirmed the rapidity of the regenerative process and liver biopsies at 6 and 12 months did not show any late changes. There is no relation between the duration of liver ischemia in the limits of this study and post operative morbidity rate, which is more influenced by the magnitude of the resection and the quality of the liver remnant.

Effects of administration route on pharmacokinetics of aspirin in the rabbit.

The absorption of aspirin used in the form of lysine acetylsalicylate was studied in the rabbit. Each animal received the drug by three routes: intravenous, gastric and duodenal. Plasma concentrations of acetylsalicylic acid (ASA) and salicylic acid (SA) were compared. ASA plasma concentrations obtained after gastric or duodenal administration were low compared to those after intravenous injection. Concentrations were 2 to 5 times higher after gastric than duodenal administration. SA plasma concentrations were lower at the beginning of the experiment for gastric than for duodenal administration; after 90 min the concentrations were similar. A better absorption of aspirin (as lysine acetylsalicylate) after administration occurred in the stomach than in the duodenum, but the amount of ASA which reached the central compartment was quite poor.

Influence of the fatty acid composition of high-density lipoprotein phospholipids on the cholesterol efflux from cultured fibroblasts.

The purpose of this work was to determine whether the changes induced by dietary manipulations in the chemical composition of high-density lipoproteins (HDL) (particularly phospholipid fatty acid composition) modified their capacity to promote [3H]cholesterol efflux from cultured fibroblasts. Plasma HDL were obtained from subjects fed for six successive long periods on diets consisting of one predominant fat: peanut oil, corn oil, olive oil, soybean oil, low erucic acid rapeseed oil or milk fats. The [3H]cholesterol efflux from cells in the presence of plasma HDL was studied by means of normal adult human fibroblasts in culture. The [3H]cholesterol efflux from fibroblasts appeared to be independent of the overall composition of HDL and of the degree of saturation of the HDL phospholipid fatty acids, but it was correlated with the phospholipid fatty acid chain length. The [3H]cholesterol efflux from fibroblasts is highly and positively correlated with the sum of the HDL phospholipid C20, C22, C24 fatty acids, and negatively correlated with the sum of the HDL phospholipid C18 fatty acids.

Dietary modifications of low-density lipoprotein fatty acids in humans: their effect on low-density lipoprotein-fibroblast interactions.

The chemical composition and metabolism of low-density lipoproteins (LDLs) in a population of Benedictine nuns were studied after 5-month periods during which the predominant dietary fats were sunflower oil, fluid of palm, peanut oil, milk fats, low erucic acid rapeseed (LEAR) oil, corn oil, olive oil, soybean oil. The population was divided into three groups. The control group (C) included 12 subjects selected at random by taking 2 subjects per age pool among those with plasma cholesterol less than 230 mg/dl. Groups H1 and H2 were selected in the same way among those with plasma cholesterol less than 230 mg/dl. Groups H1 and H2 comprised 6 subjects and differed from each other in the amount of plasma cholesteryl esters, i.e., below and above the mean value of group C. Changes in LDL composition, according to the dietary fat, were associated with changes in LDL catabolism studied in fibroblast cultures, but no significant differences were found between the three groups.

Effects of different dietary intake of essential fatty acids on C20:3 omega 6 and C20:4 omega 6 serum levels in human adults.

Four diets which differed in fatty acid composition were provided for five months each to a group of 24 healthy nun volunteers. The diets contained 54% carbohydrates, 16% proteins and 30% lipids. One-third of the lipid part remained unchanged during the whole study, and two-thirds were modified during each period. For this latter portion, one of the following dietary fats was used: sunflower oil, peanut oil, low erucic acid rapeseed (LEAR) oil or milk fats. This procedure allowed an evaluation of the effects of various amounts of dietary linoleic acid (C18:2 omega 6) and alpha-linolenic acid (C18:3 omega 3) on the serum level of their metabolites. A diet providing a large amount of linoleic acid (14% of the total caloric intake) resulted in low levels of dihomo-gamma-linolenic acid (C20:3 omega 6) and arachidonic acid (C20:4 omega 6) in serum phospholipids and cholesteryl esters. A diet providing a small amount of linoleic acid (0.6% to 1.3% of the total caloric intake) induced high levels of omega 6 fatty acid derivatives. Intermediate serum levels of C20:3 omega 6 and C20:4 omega 6 were found with a linoleic acid supply of about 6.5% of the total caloric intake. Serum levels of omega 6 metabolites were not different after two diets providing a similar supply of C18:2 omega 6 (4.5% to 6.5% of the total caloric intake), although in one of them the supply of C18:3 omega 3 was higher (1.5% for LEAR oil versus 0.13% for peanut oil).(ABSTRACT TRUNCATED AT 250 WORDS)

[Does proprioception of the extrinsic eye muscles participate in equilibrium, vision and oculomotor action?]. / La proprioception des muscles extrinsèques de l'ceil participe-t-elle à l'équilibre, à la vision et à l'oculomotricité?

Extrinsic eye muscles respond to both proprioceptive and visual impulses. Histology of ocular proprioceptive receptors shows them to be qualitatively and original, neuromuscular bundles are found in primates, and so called "palisade sensory nerve endings" in felines. Golgi's osteotendinous receptors are apparently absent. The number of muscle receptors is high and their proportion in relation to muscle weight even more so. The afferent pathway for this sensory system initially accompanies the motor fibers of oculomotor III, IV, ans VI nerves. Some fibers continue with these nerves to the brain stem while others join the ophthalmic branch of the trigeminal nerve (probably in the cavernous sinus). Cell bodies of proprioceptive fibers are located either in the mesencephalic root of the trigeminal nerve and in the Gasserian ganglion. The superior colliculus, center of eye-head coordination integration, also receives proprioceptive data. Proprioceptive afferent signals also project on two cerebellar cortex regions, one in the VI th and VII th lobules of the posterior lobe vermis, the other in the flocculus, all major centers for control and interaction of visuocervicovestibular activity. Extraocular proprioceptive impulses play an important role as do visual influx, in the maturation of the visual cortex in mammalia. Moreover, maintenance of binocular integration appears to require both coherent binocular vision and balanced bilateral, extraocular afferent impulses. Clinical consequences are multiple. Proprioceptive imbalance due to oculomotor dysfunction could explain the attendant visual deficit, which is reversible after correction of they motor disorder. Forced excentration of gaze provokes equilibrium disturbances in normal subjects. In cases of oculomotor palsy, the accompanying vertigo often observed could thus be due à lack of coordination between the intention of movement and its execution. Many oculomotor signs are dependent on the position of gaze alone, in the absence of any visual guide: end-position nystagmus gaze nystagmus, rebound nystagmus, gaze drift, periodic alternating and vertical superior nystagmus, ocular flutter and opsoclonus, nystagmus retractorius, etc. Proprioceptive impulses from extrinsic eye muscles are probably necessary for assessment of orbital coordinates of the ocular globe position during target fixation: this emphasizes the importance of this proprioceptive factor in the origin of ocular jerks. Proprioceptive impulses may play a crucial role in the triggering of the rapid phase of nystagmus, thus conditioning the variations in amplitude seen in provoked nystagmus tests.

Modification in the composition and metabolic properties of human low density and high density lipoproteins by different dietary fats.

The chemical composition and metabolism of lipoproteins in a population of Benedictine nuns were studied after 5-month periods during which the predominant dietary fats were sunflower oil, peanut oil, palm oil, or milk fats (butter and cream). The population was divided into three groups. The control group (C) included twelve subjects selected at random by taking two subjects per age pool among those with plasma cholesterol less than 230 mg/dl. Groups H1 and H2 were selected at random in the same way, among those with plasma cholesterol greater than 230 mg/dl. Each group comprised six subjects and differed from each other in the amount of plasma cholesteryl esters, i.e., below and above the mean value of group C, for H1 and H2, respectively. Changes in the degree of saturation of the predominant fat of the diet were associated with changes in both the chemical composition of lipoproteins and their cellular metabolism studied in fibroblast cultures. No significant difference between the normocholesterolemic subjects of group C and the "high risk" subjects of groups H1 and H2 was found.