Treatment of localised prostate cancer with transrectal high intensity focused ultrasound.

With the advent of PSA dosing, an increasing number of prostate cancers are being detected at a local stage. Since 1989, our group has been developing a research project with the aim of establishing treatment of localised prostate cancer by means of HIFU. The treatment is performed transrectally, using ultrasound imaging guidance only. The quality of HIFU treatment depends on four factors: the intensity of the transmitted pulse, the exposure time, the signal frequency, and the time between two firing bursts. The lesions are created by a thermal effect. Their slightly conical form is due to the absorption of ultrasound by tissue, enhanced by cavitation bubbles. Results obtained since 1993 demonstrate that transrectally administered HIFU treatment achieves local control of localised prostate cancer in 80% of cases, with 70% complete success and 30% partial response. The use of an annular array probe with variable focus and frequency should significantly improve results in the future. Finally, real time visual display of the damaged tissue via differential imaging of the attenuation coefficient should give the surgeon an instant appreciation of the result of the sequence. It would thus be possible to repeat treatment of insufficiently covered zones in the same session.

Joint influence of alcohol, tobacco, and coffee on biological markers of heavy drinking in alcoholics.

BACKGROUND: Recent reports suggest that gamma-glutamyl transferase (GGT) decreases with coffee intake. The aim of this study was to examine the joint influence of alcohol, tobacco, cotinine, coffee, and caffeine on biological markers of heavy drinking in an alcoholic population. METHODS: Subjects were 160 alcohol-dependent inpatients. Biological assessments, performed at admission, were plasma levels of GGT, apolipoprotein AI, aspartate aminotransferase, and mean corpuscular volume (MCV), and urine cotinine and caffeine indexes. Years of alcohol abuse and of smoking, alcohol and coffee intake, and smoking rate were estimated in a semistructured interview, and Fagerström Tolerance Questionnaire was completed by inpatients. RESULTS: Coffee intake, but not caffeine, correlated negatively with biological markers of heavy drinking, after controlling for alcohol and tobacco intake. Years of smoking correlated positively to MCV, after controlling for alcohol and coffee intake. CONCLUSIONS: Concerning the effect of coffee, the most likely hypothesis is that noncaffeine coffee fractions have a protective effect on liver cells. Concerning the effect of smoking, one can propose that the increase of MCV with smoking could be a consequence of carbon monoxide inhalation, leading to hypoxemia, or of folate deficiency.

In vivo effects of high-intensity ultrasound on prostatic adenocarcinoma Dunning R3327.

High-intensity ultrasound has been used to treat Dunning R3327 prostatic adenocarcinoma implanted s.c. in Fischer Copenhagen rats. Focused ultrasound was generated with a 1-MHz transducer and energy was provided by a 7.5-kW power amplifier. Seventy-four rats were treated using two different sublines of Dunning tumor. Study 1 dealt with 49 rats with the Mat-Ly-Lu subline, treated with acoustic intensities ranging from 300 to 2750 W/cm2. Of the 49 rats in Study 1, 30 had complete tumor necrosis and 19 had no effect; of the 30 who had complete local tumor necrosis, 14 had local relapse, 9 had distance metastases to lung and nodes without local occurrence, and 7 remained free of tumor and were still alive 12 months after treatment. In Study 2, 25 rats with AT2 subline were treated with an intensity of 820 W/cm2. Similarly for Study 2, there was complete local tumor necrosis in 24 of 25 animals, with local regrowth in 7 of 24 and no recurrence of metastasis in the remaining 16 after a follow-up of 3 months. These results suggested that high-intensity focused ultrasound could be useful for the treatment of small localized cancerous tumors such as low-grade prostate carcinoma.

Effects of high-energy focused ultrasound on kidney tissue in the rat and the dog.

In vivo tissue destruction was performed on 124 rat and 16 canine kidneys by focusing high-intensity ultrasound with a 1- and 2.25-MHz transducer. A precise tissue lesion was obtained in both models which varied in size according to the number of firings and the acoustic intensity. In the rat experiments, which were used to define the constants necessary to produce a localized tissue lesion at the focus of the transducer, the lesions obtained were either coagulating necrosis or a 'punched out' cavity which represented the threshold of tissue ablation. In the canine experiments, a kidney lesion was achieved in 10 animals (63%) extracorporally. These lesions were also histologically determined to be coagulation necrosis. These lesions are created by highly focused ultrasound and are caused most likely by a combination of cavitation and thermal effects, depending on the duration and frequency of the ultrasound bursts. Exact mechanism of this effect is explored as well as potential clinical applications in treating kidney, liver, and prostate tumors in humans.

[Noninvasive hemodynamic monitoring via the integration of data obtained by ECG, aortic flow by Doppler esophageal probe and by finger plethysmography]. / Monitorizzazione emodinamica non invasiva attraverso l'integrazione dei dati ottenuti con l'ECG, con il flusso aortico mediante sonda esofagea Doppler e con la pletismografia digitale.

The aims of this work are to describe the general and technical characteristics of a new device for the noninvasive monitoring of patients in intensive care and during general anaesthesia, and the results concerning the reliability of this method. An ultrasonic esophageal probe and an echo-Doppler device have been used to obtain continuous data of the aortic diameter and of blood velocity. Aortic output is calculated automatically. This method, together with other non-invasive monitoring techniques (blood pressure, heart rate, rhythm and cardiac conduction), gives on the one hand the data of aortic output, systemic peripheral resistance and stroke volume; on the other, through a computerized elaboration, the systolic time intervals (PEP pre-ejection period, LVET left ventricular ejection time, QS2 electromechanical systole, PEP/LVET ratio of PEP to LVET). The validation of STI data, has been obtained through 125 comparative measurements for each of the three parameters. The data obtained through the aortic velocity waveform in descending aorta (pulsed Doppler) have been compared with those obtained through the aortic pressure waveform (intra aortic catheter). The correlation was: PEP 0.92, LVET 0.95, QS2 0.93. The clinical application of this method supplies data concerning cardiac load, after-load and indirectly cardiac pre-load. This non-invasive procedure gives us a continuous measurement of hemo-dynamic situation, which allows the physician to plan and evaluate the therapeutical efficacy. Finally new pathologic events may be opportunely faced.

A computerized bioelectrical cardiac monitor.

The use of a micro-computer improves the performance of an impedance cardiograph. The impedance signals and the ECG are real-time processed and four analog signals are displayed on the screen. A beat-to-beat estimation of cardiac output and several indexes are computed and displayed. User's interface is by interactive screen menus. Some facilities permit data identification, storage and post-processing. The software has been designed in such a way as to be adaptable to each specific application and to enable the development of new routines for cardiac signal processing. The signals recorded in healthy patients are in agreement with the results of other similar studies.

[Methods of stimulation in visual electrophysiology]. / Méthodes de stimulation en électrophysiologie visuelle.

After introducing physical and physiological stimulation parameters, the authors present different techniques and discuss their clinical usefulness for the investigation of the visual system: flashes: chiefly 'ganzfeld' stimulators (whole field or local stimulation). A solution using optic fibres incorporated in a sclero-corneal electrode built in our laboratory is presented; patterns: bars or chekerboards, especially on TV screens. Advantages and inconveniences of video images are discussed; other techniques: essentially endocular laser interference fringes, electrical stimulations, high level flashes for ERP and binocular studies, particularly dynamic random dot pattern EVP. In conclusion, the necessity for the careful control of stimulation characteristics and for a strategy suitable for clinical examination is discussed.

[Metastases of the cervico-occipital junction. The value of tomographic detection of prefracture forms (author's transl)]. / Les métastases de la charnière cervico-occipitale. Intérêt de la détection tomographique des formes pré-fracturaires.

The authors stress the frequency of metastases of the cervico-occipital junction unrecognized in medical literature: 30 cases have been diagnosed within four months. They report their different patterns and complications and insist on the prefractured pattern with osteolysis of the body of C-2 which can be shown only by polytomography. The authors propose that a tomographic study of the cervico-occipital junction should be systematically included in every analysis of metastatic extension of osteophilic tumors.