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Purpose: To evaluate erectile function (EF) prospectively from 1 to 2 years post-brachytherapy in patients with a baseline IIEF5 score>16., Methods: Between 2007 and 2012, 179 patients underwent an exclusive brachytherapy for localised low risk prostate adenocarcinoma. Neo-adjuvant hormotherapy (15.6%) and post-brachytherapy intake phosphodiesterase inhibitors (PDE5i) were not considered as exclusion criteria. EF was evaluated via a scoring questionnaire IIEF5 before the surgical implantation, at month 12 and 24 post-operation. Only patients with an initial IIEF5 score>16 were included., Results: Of the 179 patients, 102 (57%) had a baseline IIEF5>16. At 12 months, 51.1% maintained an IIEF5>16 and 24.5% had a mild to moderate erectile dysfunction (ED), so that a total of 75.6% with IIEF5≥12. About 18% of patients had used PDE5i. At 24 months, 53.2% had an IIEF5>16 and 80.6% had an IIEF5≥12. Severe ED was reported in only 14.5% of the patients. The mean IIEF5 was 16.2 with an average decline of 5 points from the initial stage. All patients who were treated with PDE5i (27%) could have sexual intercourse. EF at baseline was reported as the only predictive factor of ED in multivariate analysis, 70% of patient without ED initially, had an IIEF5>16 at 1 and 2 years., Conclusion: Severe ED was quite rare (14%) during the first 2 years post-brachytherapy and more than half of patients maintained an IIEF5>16. The main predictive factor was the erectile function at baseline., Level of Evidence: 4., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Aortoduodenal fistulas are rare and severe complications of aortic prostheses. The clinical picture usually includes digestive features and fever, unlike our observation where fistula was revealed by heavy and swollen leg with cutaneous septic abscesses but no digestive signs., Patients and Methods: A 59 year-old man who had undergone aortoiliac prosthetic repair of an aortic aneurysm 6 years earlier was hospitalized in a dermatology department for fever beginning three months previously associated with a heavy and swollen leg. Clinical and ultrasound examination revealed vascularised cutaneous nodules on the leg. Abdominal CAT showed left iliac venous compression caused by periprosthetic inflammation and particularly retroperitoneal fluid accumulation, gas bubbles in which suggested aortoduodenal fistula, which was confirmed during surgery. Aspirative puncture of abscesses was positive for E. Coli and Candida Glabatra., Discussion: Aortoduodenal fistula is a rare complication of vascular prostheses. Clinical features include digestive symptoms and fever. However, diagnosis may be difficult and delay surgery. Cutaneous manifestations appear later and are often associated with other symptoms; they are caused by septic emboli or vascular compression. Imaging methods may assist diagnosis, but surgical procedures provide confirmation and form the cornerstone of management.

Peripheral arterial involvement is common in pseudoxanthoma elasticum. It can be the first symptom. Small and medium size arteries are most often involved. The arterial lesions are diffuse, stenotic and often with marked calcium deposition. This arterial involvement can be developed early and if happening in young patients it is of great diagnostic significance. Peripheral vascular disease is most common in the limbs. Its evolution is remarkably slow. Coronary arterial disease can induce angina pectoris but seldom myocardial infarction. In cerebral arteries, lesions consist in stenoses and aneurysmal dilatation. They are responsible for thrombotic or hemorrhagic accidents. High blood pressure is frequent. It increases the hemorrhagic risk. Aortic lesions are exceptional, and if encountered one must discuss a Marfan disease association. Visceral hemorrhages, gastrointestinal or uterine, often the first symptom, are secondary to arteriolar lesions. Histologic studies reveal narrowed arterial lumen, due to medial thickening. Media is invaded by irregular and anarchic elastic fibers. Elastic laminae are fragmented and disorganized. The abnormal elastic tissue tends to be calcified. When compared to the arterial lesions, cardiac involvement is uncommon. It has been described in the first case of literature. It essentially consists in an endocardial thickening of the auricles and of the mitral and tricuspid valves.

Radiotherapy is an effective tool in the treatment of thoracic cancers. However, radiotherapy also carries a risk of severe cardiac complications. The cancers most commonly concerned are Hodgkin's and non-Hodgkin's lymphomas (90 per cent of cases), breast cancers, especially on the left side (4 per cent) and bronchogenic cancers (2 per cent). Ionizing radiation can damage the three layers of the heart and the coronary arteries. Pericardial involvement is the most frequent, occurring in 10 to 12 per cent of cases. It generally occurs 6 to 18 months after the radiotherapy and may present either acutely (35 per cent of cases) or chronically (65 per cent of cases). It is often latent, only detected on X-rays or on ultrasound. Constrictive forms can occur, which require pericardiectomy. Myocardial fibrosis, which is anatomically common, may present as disturbances of repolarization, arrhythmia or disturbances of conduction, or even cardiac failure. Rarely, radiation damage of the coronary arteries can cause angina or myocardial infarction. These cases can benefit from coronary artery by-pass grafts. All of these lesions have a common anatomical denominator:fibrosis, which develops progressively following the radiotherapy. It has now been demonstrated that the incidence of cardiac radiation lesions can be reduced by homogeneous distribution of the dose of radiation administered to the mediastinum, by treating each side alternately, by fractionating the radiation and staggering the sessions and by reducing the cardiac mass which is irradiated.

The cardiac complications of radiotherapy have been reviewed in the light of 46 case histories collected from 16 treatment centres in France. They are usually found after radiotherapy for Hodgkin's disease and carcinoma of the breast. Although histologically there may be diffuse fibrosis involving the endocardium, myocardium and pericardium, it is pericarditis which is the usual clinical feature. It often occurs late, and takes many forms. The dry constrictive fibrous type of pericarditis is the most severe because of the amount of myocardial fibrosis usually associated with it. It is rare for there to be clinical features of myocardial fibrosis, and if present they are variable: isolated disorders of repolarisation or of conduction, or true cardiomyopathies. Lesions of the coronary arteries are exceptionally rare after radiotherapy, and involve fibrosis of the intima or atherosclerosis.

The study of coronary blood flow by radio isotpopes may determine the casual relationship between coronary artery narrowing and myocardial ischemia. Total coronary flow is measured without cardiac catheterisation by double counter technique using 84 Rb and by radionuclide angiography using 42 K and 113m in fixed on siderophilin. This is an easier method, which is very reproductible and which may be sensitised by atrial pacing. The measurement of regional coronary flow gives a better estimation of the physiological effects of coronary artery disease. Two indicators are used; radioactive gases (113 Xe and more recently 81 m Kr) and microspheres tracers. Selective coronary injection of biodegradable microspheres labelled with 99m Tc and 113m In may be used to assess the hyperemic reaction in the coronary arteriolar territory to the triiodide contrast media used in coronary angiography, and to estimate the reserve coronary blood flow. The transmural perfusion may be studied in animal experiments with non-biodegradable microspheres. Tomographic techniques should allow quantification of myocardial perfusion in man.

At the present time, the mortality during the first year following an acute myocardial infarction is in the order of 10%. It subsequently drops to 4 or 5% per year. In more than one half of cases, the death of a postinfarct patient is sudden, with the major cause being ventricular fibrillation. These patients are also threatened by another risk: recurrent infarction. For Kannel, its incidence is 13% in men and 40% in women within 5 years of the first infarct. Its mortality is higher than that of the first infarct. Beta-blockers and calcium blockers reduce the myocardial oxygen consumption by a variety of mechanisms: beta-blockers block the beta-adrenergic receptors and calcium blockers inhibit the entry of calcium into the myocardial cells. Apart from their action on the process of excitation-contraction of myocardial fibres, the calcium blockers have also an action on the coronary vessels where they suppress or prevent spasm, and on peripheral arteries, where they cause vasodilatation thereby reducing the left ventricular afterload. The anti-ischaemic activity of these molecules is demonstrated by the reduction or elimination of angina, by the improved cardiac performance during stress test and by myocardial isotopic scans. The beta-blockers have other beneficial effects, in particular, antiarrhythmic and antiplatelet aggregation related to the neutralisation of catecholamines. Their antihypertensive action is also useful in coronary patients.(ABSTRACT TRUNCATED AT 250 WORDS)