Guidance of the MitraClip® procedure by 2D and 3D imaging.

Percutaneous edge-to-edge repair using MitraClip® (Abbott Laboratories, Abbott Park, IL, USA) can be used to treat mitral regurgitation. However, real-time echocardiographic guidance is vital; and use of 3D transoesophageal echocardiography to guide the procedure has improved reproducibility, reliability and safety. This review describes the MitraClip® device - which is composed of a steerable guide catheter (SGC) and a Clip Delivery System (CDS) - and the MitraClip® procedure. The procedure consists of six steps: (1) transseptal approach and puncture; (2) introduction of the SGC into the left atrium; (3) navigation with the CDS into the left atrium to place the MitraClip® above the mitral valve; (4) crossing the valve and advancing the CDS into the left ventricle; (5) grasping the leaflets and assessment of the quality of the grasping; and (6) final mitral regurgitation assessment. This review also describes which imaging techniques are applicable to each stage of the procedure; and contains examples of the various images obtained during these steps.

3D brachytherapy for cervical cancer: New optimization ways.

Brachytherapy has known major improvements in recent decades. It represents an essential component of local treatment of cervix cancers. One major breakthrough was the advent of 3D imaging for image-guided brachytherapy. Doses could be prescribed to volumes. This allows better delineation and coverage of target volumes, as well as organs at risk (bladder, rectum, sigmoid) protection. Local recurrences have been consequently reduced and survival has been improved. In addition, improvement and development of new applicators have facilitated the delivery of interstitial treatments. Afterloading applicators, associated with 3D imaging, allow dosimetry optimization in order to improve the coverage of the target volumes (dose in 90% of the high risk clinical target volume) and to limit dose to the organs at risk. In the future, more personalized treatments will be achieved through more advanced applicators and/or by improving the accuracy of imaging at the time of brachytherapy.

[Prospective: How will renal, prostatic and urothelial tumours be treated in 10 years?] / Prospective : comment traitera-t-on les tumeurs rénales et prostatiques et urothéliales dans 10 ans ?

Forward thinking does not seek to predict the future, to unveil it as if it were already in existence, rather, its aim is to help us to construct it. Although today's epidemiological and therapeutic situations for urogenital tumours can evolve over the next 10 years, diagnostic and therapeutic methods, as well as the treatment and implementation of innovations, are already rapidly changing. Rather than reducing our prospective thinking to the therapeutic treatment of cancer only, we will aim at proposing a global sanitary vision that includes diagnosis, therapies, prevention, routine utilisation of technomedicine, genomics and even nanomedicine. This journey into the near future of tomorrow's cancerology holds the promise of being better adapted to the evolution of the medical thinking process. Imagining the way we will be treating renal, prostatic and urothelial tumours in 10 years' time is as much an introspection into our present day treatment system as a projection into its hoped for future evolution.

[New protocol combining orthodontics and implant therapy for partially edentulous adult patients. Part I: Description of the Decker protocol]. / Nouvelle approche de la thérapeutique ortho-implantaire de l'adulte partiellement édenté. Partie I : description du protocole Decker.

INTRODUCTION: The treatment of adult malocclusion is usually complex and pluridisciplinary. Its prognosis is not reliable. We present a new clinical protocol to improve the management and final result. TECHNICAL NOTE: We use a specific software (Simplant®, OMS®, Materialise Dental) and its accessory modules. It allows visualization of the expected final clinical result of the orthodontic treatment. Combined with guided-surgery, it allows placing implants at the beginning of treatment in a position that is compatible with the final position. The implants serve as absolute anchorage for dental motions during the orthodontic step; it is also used to support the final prosthesis. The treatment is thus optimized and its prognosis is improved. Finally, the reversed surgical sequences shorten the treatment thus promoting the compliance of patients.