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To analyze, in patients with prostate cancer (PC) potentially eligible for active surveillance (AS), whether multiparametric-MRI (mp-MRI) predicts presence of clinically significant cancer on radical prostatectomy (RP) specimen.We identified 77 men with PC eligible for AS (PSA≤15ng/mL, stage≤T2a, Gleason score≤6, up to 3 positive cores, maximal cancer core length≤5mm) who underwent RP between 01/2008 and 08/2015. All patients had prebiopsy mp-MRI followed by systematic±targeted biopsies. For each patient, the likelihood of the presence of cancer on mp-MRI was assigned using Likert scale (1 to 5). The predictive factors for the presence of significant cancer on RP specimen (Gleason score≥7 and/or tumoral maximal diameter10mm) were evaluated using logistic regression.Median age was 61 and median PSA was 6.7ng/mL. Overall, 49 (64%) patients had a positive mp-MRI (score≥3). Clinically significant cancer on RP specimen was found in 45 (58%) patients (69% in MRI-positive patients vs 39% in MRI-negative patients). In multivariate analysis, a positive MRI was a predictive factor for the presence of significant cancer on the surgical specimen (OR=3.0; CI95% [1.01-8.88]; P=0.04), as was age (OR=1.17; CI95% [1.05-1.31]; P=0.004) and PSAD (OR=1.10; CI95% [1.01-1.20]; P=0.02).Mp-MRI is a useful exam for selecting patients eligible for AS even if the situation remains unclear after prostate biopsies including targeted biopsies. Upon confirmation by further studies, mp-MRI should be considered as an independent criterion before entering an AS program.4.

To evaluate the contribution of multiparametric MRI (MRI) and targeted biopsies (TB) in the selection and follow-up of patients under active surveillance (AS).A single-center, retrospective cohort study on 131 patients in AS, with following criteria:≤cT2 stage, PSA≤15ng/mL, Gleason score≤6,≤3 positive biopsies and maximum tumor length≤5mm. Patients' selection and follow-up was performed by the combination of systemic biopsies (SB) and mpMRI±TB. Reclassification was defined by a Gleason score6 and/or a maximum tumor length5mm.Overall, 29 patients (22.1 %) were reclassified. Reclassification free survival rate was 93 % and 70 % at 1 year and 4 years respectively. Reclassification independent risk factors were: PSA density0.15ng/mL/cmFor patients under AS, mpMRI decreases reclassification rates over time through better initial detection of significant cancers. Its high NPV makes it an efficient monitoring tool to distinguish patients with low risk of reclassification.4.

Multiparametric MRI (mp-MRI) of the prostate currently provides stable and reproducible performances. The usefulness of dynamic contrast-enhanced (DCE) sequences is currently challenged, as they sometimes only confirm what has already been observed on diffusion-weighted imaging (DWI) and require the additional purchase of a contrast agent. Eliminating these sequences may help accelerate the use of MRI in addition to, or in lieu of, prostate biopsies in selected patients. However, many studies show that these sequences can detect lesions invisible on T2-weighted and diffusion-weighted images, better assess cancer extension and aggressiveness, and finally help detecting recurrence after treatment. We present the various applications of dynamic MRI and discuss the possible consequences of its omission from the current protocol.

To assess long term biochemical recurrence free survival after radical prostatectomy according to open, laparoscopic and robot-assisted surgical approach and clinicopathological stage.A cohort study of 1313 consecutive patients treated by radical prostatectomy for localized or locally advanced prostate cancer between 2000 and 2013. Open surgery (63.7%), laparoscopy (10%) and robot-assisted laparoscopy (26.4%) were performed. Biochemical recurrence was defined by PSA0,1ng/mL. The biochemical recurrence free survival was described by Kaplan Meier method and prognostic factors were analysed by multivariable Cox regression.Median follow-up was 57 months (IQR: 31-90). Ten years biochemical recurrence free survival was 88.5%, 71.6% and 53.5% respectively for low, intermediate and high-risk D'Amico groups. On multivariable analysis, the worse prognostic factor was Gleason score (P0.001). Positive surgical margins rate was 53% in pT3 tumours and 24% in pT2 tumours (P0.001). Biochemical recurrence free survival (P=0.06) and positive surgical margins rate (P=0.87) were not statistically different between the three surgical approaches.Biochemical recurrence free survival in our study does not differ according to surgical approach and is similar to published series. Ten years biochemical recurrence free survival for high-risk tumours without hormone therapy is 54% justifying the role of surgery in the therapeutic conversations in this group of tumours.3.

Myelolipomas and extramedullary hematopoietic tumors are uncommon benign tumors. They are variably composed of mature adipose tissue and hematopoietic tissue. Myelolipoma is usually observed in the adrenal gland and extramedullary hematopoietic tumors in the liver and spleen but may occasionally be found within solid tumors.A 62-year-old man without previous haematological history presented with a voluminous solitary bilateral renal tumor. Contrast-enhanced ultrasound CT-scan and scintigraphy with technetium-99m-nanocolloid and indium-111-chloride bone marrow were highly suggestive of extramedullary hematopoietic tumor. CT-guided biopsy suggested a diagnosis of myelolipoma. An atypical hereditary spherocytosis, undiagnosed until now, was demonstrated.We report, for the first time to our knowledge, a border form between extramedullary hematopoiesis tumor and myelolipoma of renal localisation revealing a hereditary spherocytosis in an adult patient.

The incidence of testicular nodules discovered during infertility evaluation is increasing. These nodules are suspicious of malignancy. There is no paraclinical examination which allows histological orientation to these nodules. The recommendations propose priority treatment by total orchidectomy.Through a retrospective cohort study of infertile patients, our goal is to study the enhancement of testicular nodules after injection of ultrasound contrast. The secondary objective is to determine whether CEUS may argue in favor of conservative treatment. From june 2010 to march 2013, 24 patients had underwent ultrasound contrast study of abnormal testicular parenchyma detected prior to infertility evaluation carried ultrasound. The characteristics of ultrasound enhancement were correlated with the pathological findings of surgical patients and proposed treatments (surgery or surveillance).Fifteen patients were followed up, 9 were operated (7 partial orchidectomies, 2 total orchidectomies). Histological analysis found four Leydig cell tumors, 2 Sertoli cell tumors and 3 seminomas. No adverse changes were noted during the follow-up. This study showed a typical semiology of early, intense and homogeneous enhancement with a phenomenon of wash in 100% of Leydig cell tumors. All Leydig cell tumors have been treated by partial orchidectomy. Seminomas have intense enhancement in 100% of cases. There was a phenomenon of wash in 2 out of 3 cases. When a wash in was described, it was always described as heterogeneous. All seminomas were finally treated by total orchidectomy. The sensitivity and positive predictive value of ultrasound intense enhancement for the diagnosis of testicular cancer was 89% (Se) and 80% (PPV).There is a semiology of ultrasound enhancement of testicular nodules with features that can guide in favor of a malignant tumor, seminoma or Leydig cell tumor. If a prospective study was undertaken, these arrangements could guide us to treatments promoting preservation of the testicular parenchyma.

To construct a phantom for prostate cancer laser based thermotherapy treatment planning and simulation.A realistic and adaptable prostate phantom was designed. It exhibits the following properties: valid and complete description of the prostate anatomy, material with similar optical properties of prostate tissues and compatibility with clinical imaging protocols mainly multiparametric magnetic resonance (MR) and transrectal ultrasound imaging (TRUS).Preliminary experiments with the phantom using an interstitial laser treatment protocol allowed obtaining results similar to those obtained on preclinical model.These results proved that this phantom could allow a real simulation of laser therapy procedure: target definition and fibers' placement optimization using MR imaging, treatment delivery, and finally treatment monitoring using TRUS imaging.

Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound.A retrospective review of all patients treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported.Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign.The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe.

Computerized detection of prostate cancer on T2-weighted MR images.The authors combined fractal and multifractal features to perform textural analysis of the images. The fractal dimension was computed using the Variance method; the multifractal spectrum was estimated by an adaptation of a multifractional Brownian motion model. Voxels were labeled as tumor/nontumor via nonlinear supervised classification. Two classification algorithms were tested: Support vector machine (SVM) and AdaBoost.Experiments were performed on images from 17 patients. Ground truth was available from histological images. Detection and classification results (sensitivity, specificity) were (83%, 91%) and (85%, 93%) for SVM and AdaBoost, respectively.Classification using the authors' model combining fractal and multifractal features was more accurate than classification using classical texture features (such as Haralick, wavelet, and Gabor filters). Moreover, the method was more robust against signal intensity variations. Although the method was only applied to T2 images, it could be extended to multispectral MR.

Prostate cancer (CaP) has become the most frequent cancer in France and represents the 4th cause of mortality by cancer. Main risk factors include age, family history, black ethnic origin and carcinogenesis results from interaction between environmental and endogen factors. This work aimed to review main data and strategic trends about evolution of prevention and early diagnosis of CaP. Research topics considered as priorities results from the main objective including definition of most efficient medico-economic strategies according to epidemiology, diagnostic and therapeutic modalities and ethno-sociologic particularities, including in the schema presently used (PSA/biopsies): 1) new markers (genetic, serum and urinary), measurable environmental risk factors and potential prevention actions; 2) functional imaging (new techniques including contrast echography, dynamic MRI, spectro-MRI) in order to avoid unnecessary biopsies (60-70% biopsies are negative); 3) optimization of biopsies technique in identifying tumor zones in order to decrease false negative biopsies (about 15% of CaP0,5 cm3 but of high grade are missed in the first set of biopsies) and in improving the representativity of the tumor sample biopsied (discordance of about 40% between biopsy data and complete pathological analysis of prostatectomy specimen); 4) development of predictive models in order to perform individual prediction taking into account several risk factors (clinical and molecular) and genes/environment interactions in order to offer rational help in diagnostic and primary prevention procedures.

Photodynamic therapy (PDT) is an innovative therapeutic modality in urologic oncology.We reviewed the current literature on principles and modalities of PDT in prostatic oncology.Focal therapy of prostate cancer is an application field of PDT. Clinical phase II studies are ongoing to determine PDT efficacy and safety in this indication. PDT as salvage treatment after prostatic radiotherapy has been tested. Carcinologic results were promising but important side effects were reported. Individual dosimetric planification is necessary to avoid this toxicity.PDT first clinical experience for prostate cancer has showed its technical feasibility. Several research ways are currently in study to improve carcinologic efficacy and to limit potential side effects.

Evaluation of patients with laryngeal and hypopharyngeal tumors is based on multidetector CT imaging. The cervicomediastinal CT protocol and general guidelines with regards to planning and acquisition will be detailed. The primary role of imaging is accurate tumor staging but also detection of possible tumor extension to the superior aerodigestive tract and nodal areas. Therefore, images are acquired from the skull base to the cervicomediastinal junction. A chest CT must also be performed to look for distant metastases or other primary tumor. Deep tumor extension, detected only by imaging, is very important to consider for therapeutic planning: surgery or chemoradiotherapy. In case of surgery, accurate evaluation of tumor extension is of great importance to determine whether to perform partial or total surgery. Cervical nodal metastases are very common with laryngeal and hypopharyngeal carcinomas, and accurate staging of nodal disease is important.

International audience; A shift in the use of prostate MR for diagnosis, staging, and pre-treatment planning over the last several years has modified the MR protocols. Classically used to detect extra-prostatic tumor, MR now plays a role for diagnosis (pre-biopsy evaluation in a patient with elevated PSA and suspected cancer in an unusual site), treatment planning (prostate mapping), and follow-up after treatment (evaluation for local recurrence or follow-up after HIFU, radiation therapy, or focal treatment...). Imaging protocols at 1.5T and 3.0T combine morphological T2W imaging with functional sequences (perfusion imaging, diffusion imaging, spectroscopy) using high-resolution phased array pelvic coils or "combined" coils (added endorectal coil). To promote acceptance by clinicians and increased access to patients, the indications for prostate MR must be better defined (and provide useful data to urologists), the cost must be reduced, and results must be more reproducible and standardized.

To optimize the MDCT urogram protocol for assessment of the upper tracts. To assess the value of furosemide injection.Prospective study comparing excretory phase imaging at 450 seconds in 67 patients assigned to 3 groups: a group without furosemide (f=0), a group with 20 mg furosemide (f=20), and a group with 10 mg furosemide (f=10). 3D MIP images were generated. Two experienced radiologists blinded to protocol specifications analyzed the quality of opacification the upper tracts, divided in 8 segments and urine density at the renal pelvis.The injection of 20 mg of furosemide significantly improved the opacification of the upper tracts with complete or near complete opacification in 82.6% of cases compared to 43.5% and 19% for the F=10 and f=0 groups respectively. Density measurements were 5 times less for the f=20 and f=10 groups compared to the f=0 group.Furosemide is useful for MDCT urography by improving upper tract opacification and filling: the reduced contrast concentration in the better distended and fully filled upper tracts improves evaluation of ureteral lumen and wall abnormalities.

In radiotherapy planning, target volumes and organs at risk delineation are a tedious and time-consuming task. In this paper we address a method to assist the radiologist in this task. We developed a 3D deformable model for prostate segmentation and used a seeded region growing algorithm for bladder and rectum delineation on MR images. Evaluation of the methods is made by comparison of the results to manual delineation in 24 patients. The following parameters were measured: volume ratio (V R) (automatic/manual), volume overlap (V O) (ratio of the volume of intersection to the volume of union, optimal value=1), and correctly delineated volume (V C) (percent ratio of the volume of intersection to the manual defined volume, optimal value=100). For prostate the V R, V O and V C were 1.13 (+/-0.1), 0.78 (+/-0.05) and 94.75 (+/-3.3), respectively. For rectum, the V R, V O and V C were 0.97 (+/-0.1), 0.78 (+/-0.06) and 86.52 (+/-5), respectively. V R, V O and V C were 0.95 (+/-0.03), 0.88 (+/-0.03) and 91.29 (+/-3.1) for bladder, respectively.

This review describes the transrectal ultrasound (TRUS) features of prostate cancer (PC), discusses the role of TRUS in the detection of PC and defines the modalities of biopsies in patients with suspected PC, particularly concerning prevention of complications, the number of biopsies and the biopsy schemes ensuring an optimal cancer detection rate. TRUS alone has limited potential to identify PC because of frequent multifocality of cancer within the prostate, the variable sonographic appearance of prostatic tumors, the poor specificity of focal US abnormalities, and the substantial percentage of isoechoic PC. Over the past decade, the sextant biopsy technique has emerged as the standard of care in the detection of PC. However, limitations in cancer detection have been appreciated, particularly a false-negative rate approaching 20%. This high failure rate has led investigators to refine biopsy techniques to improve cancer detection and to increase the total number of cores. Currently, recommendations include increasing the biopsy number to a minimum of 10-12 cores, including sampling of the lateral prostate. Refinements in imaging technologies (power Doppler sonography, microbubble intravenous sonographic contrast agents, and MR spectroscopy or dynamic contrast MR imaging) should eventually improve targeting of prostate needle biopsy and reduce false-negative biopsies.

Medical imaging has an important role in the diagnosis and treatment options of prostate cancer (TRUS guided biopsies, MRI). The knowledge of the different types of cancers, their preferred topography, imaging features, extension pattern, and also the important items that may help the surgical procedure (or any other treatment) are as many crucial key points for optimal management of patients.

This review analyzes the role of imaging in the diagnosis, follow-up and management of urinary tract infections. Uncomplicated infection of the urinary tract is frequent and usually resolves rapidly with treatment; in such cases imaging is unnecessary except to exclude dilatation or the existence of an obstacle. Progression towards complex infection often occurs in patients with predisposing factors. Imaging helps in evaluating the extent of the disease; it has a role in the selection of therapy and interventional procedures.

Urogenital bilharziasis is a well-known disease that seldom is encountered in western countries. Therefore, bilharziasis usually only is considered after tuberculosis, the main differential diagnosis, has been excluded. Using this case, we will discuss the value of different imaging techniques (especially that of CT combined with transrectal US) for diagnosing bilharziasis and review specific criteria to more easily distinguish both pathologies.

Uncomplicated infection of the urinary tract is frequent and usually resolves rapidly with treatment and imaging is unnecessary. Progression to complex infection often occurs in patients with predisposing factors. Imaging assists in evaluating the extent of disease, plays a role in directing therapy and guides interventional procedures if necessary. This pictorial essay reviews the role of imaging and intervention in infections of the urinary tract.

Objective: To characterize the phenotypes of patients with juvenile and adult-onset acid maltase deficiency (AMD) in the French population and correlate them with genetic defects. Background: AMD is an autosomal recessive disorder caused by the absence of the enzyme acid α-glucosidase (GAA). Patients are generally compound heterozygotes for various mutations in the GAA gene. The most common mutant allele is a −13T to G transversion in intron 1. Methods: The authors performed a clinical, biochemical, and genetic study on 21 unrelated patients with juvenile and adult-onset AMD. Results: Although onset of progressive muscle weakness occurred during adulthood in all cases but one, presence of mild, nonprogressive muscular symptoms appearing during childhood was detected in 16 patients. Eighteen patients had a similar clinical pattern with pelvic girdle muscle weakness predominating in glutei and thigh adductors. Restrictive respiratory insufficiency with vital capacity less than 60% was noted in eight patients, and respiratory failure was the first manifestation in two cases. All patients but one were compound heterozygotes, and 17 carried the IVS1 (−13T → G) transversion (one patient was homozygous for this mutation). The two mutated alleles were identified in 10 cases, with 13 different mutations detected in the GAA gene. There was no clear correlation between the type of mutation and phenotype. Conclusions: This study shows a high genetic heterogeneity of juvenile and adult AMD in the French population. The absence of genotype–phenotype correlation suggests a complex physiopathology that requires further investigations.

Thirty patients, submitted to 34 carotid endarterectomies, from September, 1992 to April, 1996, on Hospital Albert Einstein, São Paulo, have been studied. In these surgeries, Middle Cerebral Artery (MCA) was miniaturized with Transcranial Doppler (TCD). The purpose of this study were to verify the relationship between MCA blood flow velocity with postoperative neurologic complications: studying the velocity variations with risk of cerebral low perfusion and carotid stump back pressure, during carotid clamping; confirming that the TCD information, could show when it is necessary to use shunting, and its efficiency; and to know whether the method could detect intraoperative embolization. The equipment used was a Transpect TCD-EME 2000. During surgery, when carotid stump back pressure was bellow of 54.4 mmHg, Pruitt-Inahara shunt was applied. The flow velocity value observed with TCD was divided in 3 parts: phase 1, basal, since anesthesy induction until carotid clamping; phase 2, clamping, during the period when the carotid artery was occluded; phase 3, post-declamping, from the time the carotid artery was declamping until the end of surgery. The MCA flow velocity was available on three phases, in cm/s and percentually on phases 2 and 3, in relation to basal phase. The embolizations, detected by TCD, were classified in: a) a few embolizations in less than 10 second period, b) many embolizations in more than 10 second period. Based on the results obtained, its possible to conclude that the MCA flow velocity is related to the risk of cerebral low perfusion during carotid clamping; it was not possible to stablish any relation of MCA flow velocity to carotid stump back pressure; the TCD informs when the use of shunt is necessary and its efficiency; the postoperative neurologic complications were caused by embolizations. The conclusion is that the TCD is useful and easily applicated on carotid endarterectomy.

To analyze the effects of carotid endarterectomy on the retrobulbar circulation of patients with severe occlusive carotid artery disease (OCAD) by means of color Doppler imaging (CDI).Prospective.A total of 17 consecutive patients with severe OCAD and neurologic symptoms (with a history of transitory ischemic attack or cerebral vascular accident) participated.All 17 patients underwent carotid endarterectomy. The CDI of both orbits was performed by one masked investigator before surgery and at 1 week and 1 month after surgery.Peak systolic velocity, end diastolic velocity, and resistive index of the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured. The authors compared the hemodynamic parameters at all intervals.Peak systolic and end diastolic velocities in the ophthalmic, central retinal, and temporal short posterior ciliary arteries increased significantly 1 week and 1 month after carotid endarterectomy (P0.05). After surgery, the resistive indices in the central retinal and temporal short posterior ciliary arteries decreased significantly at both intervals (P0.05). The six patients who had reversed ophthalmic artery flow before surgery showed forward ophthalmic artery flow after carotid endarterectomy. The contralateral orbits showed no significant hemodynamic change after endarterectomy (P0.05).Hemodynamic changes in patients with severe OCAD undergoing carotid endarterectomy suggest improvement in the ipsilateral retrobulbar blood flow.

Cutaneous lesions in the interdigital spaces are commonly seen in lymphedema patients and their prevention and suitable care is one of the cornerstones of any successful treatment, by preventing acute inflammations and additional worsening in limb volume and fibrosis. We obtained swab specimens from the interdigital area from 21 patients followed in the Lymphedema Unit of the Department of Vascular Surgery of the University of São Paulo; thirteen of them had lesions suggestive of tinea pedis. The pathological agent could be identified in 11 out of these 13 patients: fungal infection alone was responsible for seven lesions, Corynebacterium minutissimum for another two and both agents were isolated from two patients. Although two patients had evident clinical lesion of the skin, no fungal or bacterial species could be isolated. From the eight patients without interdigital lesions, Candida and Corynebacterium was found in one. We concluded that clinical examination has a high sensibility (84%) and specificity (91%) but the high prevalence of Corynebacterium minutissimum suggests that adequate treatment should follow careful laboratory examination.

In order to find risk factors of carotid endarterectomy related stroke (CERS), 102 consecutive carotid endarterectomies, performed within two years on 95 patients were analyzed. Age, sex, diabetes, smoking, hypertension, degree of the operated and non operated carotid stenosis, previous neurological symptoms, anesthesia, protamine, cerebral monitoring, shunt, patch, post op. hypertensive crisis and clamping time were compared with the incidence of CERS. Four patients had major neurological deficits, two of which were fatal (3.92%). Six patients had minor transitory neurological deficit (5.8%). The use of patch and a long clamping time were the only identifiable statistically significant factors (p = 0.016 and p = 0.0053 respectively) that increase the odds of a CERS.

An experimental canine model was developed in order to evaluate the role of endothelialization of aortic prostheses for protection against septicemic infection and the utilization of 131I radiolabeled bacteria for vascular experimentation. Two groups of dogs were submitted to insertion of a dacron prosthesis segment in the abdominal aorta with subsequent infusion of inert 131I radiolabeled bacteria. In the first group ("A"), formed by five dogs, the infusion was made 30 minutes after the insertion of the prosthesis and in the second group ("B"), formed by four dogs, in a new surgery performed 12 weeks after. Fragments of the animals' prostheses and aortas were collected after 30 minutes of septicemia and analyzed by scan electron microscopy and submitted to reading of radioactivity uptake by a well-type counter. The microscopy recognized a complete endothelialization of the prostheses of dogs of group "B" 12 weeks after their insertion. Statistical analysis comparing fragments of non-endothelialized prostheses, of endothelialized prostheses and aortas demonstrated that the lower radioactivity uptake of the endothelialized prostheses in relation to non-endothelialized ones was significant (p = 0.0143) and that there was no significant statistical difference in uptake in the aortas and in endothelialized prosthesis (p = 0.3173). It was, therefore, concluded that prosthesis endothelialization fully protected them against septicemic infection; bacteremia contaminated all the non-endothelialized prostheses; there was no bacterial adhesion in the endothelialized prostheses and the use of bacteria labeled with radioisotope 131I is appropriate for the study of infections in vascular prosthetic devices.

This study aimed to evaluate the retrobulbar circulatory effects of reversed ophthalmic artery flow (ROAF) on the ophthalmic artery branches by means of color Doppler imaging.The design was a case-controlled study.Among 56 consecutive patients with severe (70% stenosis) occlusive carotid artery disease, 15 patients (26.8%) with ROAF were identified. The control group consisted of 15 patients with similar degrees of carotid artery stenosis and forward ophthalmic artery flow.Arteriography and measurement of the retrobulbar hemodynamic parameters with color Doppler imaging were performed.Blood flow velocities and resistive index in the ophthalmic, central retinal, and temporal short posterior ciliary arteries were measured.Arteriography confirmed the diagnosis of ROAF in all 15 patients. There was no patient with ROAF diagnosed by arteriography and not diagnosed by color Doppler imaging. The frequency of bilateral severe occlusive carotid artery disease was significantly higher in the ROAF group (40%) compared to the control group (6.6%) (P = 0.04). Patients with ROAF showed significantly reduced vascular resistance in the ophthalmic artery (P = 0.03), higher vascular resistance, and lower blood flow velocities in the central retinal and temporal short posterior ciliary arteries (P0.05).This study suggests that patients with ROAF show a steal phenomenon, characterized by a shunt to the low-resistance intracranial circuit and reduction of retrobulbar blood flow.

Dog collars made of PVC plastic impregnated with the pyrethroid insecticide deltamethrin at 40 mg/g were investigated for their protective efficacy against phlebotomine sandflies. Collared dogs were kept separately (two untreated control dogs lived together) in outdoor enclosures, each with a kennel, in the Cevennes, southern France. To measure sandfly mortality and anti-feeding effects due to the deltamethrin-impregnated collars worn continuously by the dogs for up to 8 months, each dog was periodically sedated and exposed for 2h to 150-200 laboratory-reared Phlebotomus perniciosus females (plus c. 25 males) inside a net (1.2 m square, 1.8 m high) indoors. After dogs were removed from the nets, allowed to recover and returned to their kennels, any dead sandflies were collected from inside the net and counted. Surviving flies were kept overnight, then scored according to whether they were still alive or dead, unfed or blood-fed. From tests 2, 3, 4, 13, 20, 26 and 34 weeks after the dogs began wearing collars, the overall numbers of blood-fed female sandflies recaptured were 75 from two dogs with collars, compared with 1911 from two collarless dogs. Thus, for every 100 flies which fed on collarless dogs, only 4 fed on collared dogs, i.e. the collars protected dogs from 96% of the bites and this activity was maintained for up to 34 weeks. During the same period, the percentage of recaptured female sandflies that had fed on collared dogs was 0-12% compared to 55-95% on collarless dogs. Immediately after dogs were taken out of the nets, 21-60% of flies confined with the collared dogs were found dead, compared to 0-12% with the controls. It is concluded that, at least in the Mediterranean subregion, this insecticidal collar would protect a dog from the majority of sandfly bites and retain a killing effect for a complete sandfly season. Moreover, it seems likely that the use of collars on all dogs in a focus of Leishmania infantum would reduce contact between sandfly vectors and canine reservoir hosts sufficiently to diminish the risk of infection for humans as well as dogs.

Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and the intracavernous pressure drop test are the most used tests for the diagnosis of venoocclusive dysfunction. To verify whether patients show equivalent results in each of these four tests, and to ascertain whether there is any influence of the sequence of the exams over the results, 123 male patients with erectile dysfunction, aged 21 to 82 years (mean 48), were evaluated. All were submitted to the four tests in randomized sequence. Two criteria were used to define the normal results of pump cavernosometry and pharmaco-cavernosometry, both based on patients with normal veno-occlusive function. The incidence of normal results varied from 6.5% in pump cavernosometry according to criterion I to 64.2% in pharmaco-cavernosometry according to criterion II. Results of the four tests agreed completely (all normal or all abnormal) in 43.9% of the patients when criteria I was used and 58.3% with criteria II. Incidence of normal results in each test did not vary according to the sequence in which the exams were done. Pump cavernosometry, pharmaco-cavernosometry, gravity cavernosometry and intracavernous pressure drop test did not show equivalent results for individual patients. Results were not influenced by the sequence of the tests.

Atrial flutter and fibrillation are common in patients with Wolff-Parkinson-White syndrome. Pathophysiology of these arrhythmias is poorly understood. Treatment is empirical and oriented to symptomatology. Here we describe a patient with Wolff-Parkinson-White syndrome with paroxysmal reentrant orthodromic AV tachycardias and atrial flutter episodes that disappeared after His Bundle fulguration. This suggests that a complete AV reentry circuit favored the occurrence of atrial flutter in this patient.

In 12 patients with inter-atrial communication (ostium secundum) (IAC-OS), and ages ranging between 8 and 63 years (mean = 21 years), the ratio between pulmonary and systemic flow (QP/QS) was evaluated with the use of Doppler ultrasonography and compared with the QP/QS obtained by oxymetric measurement during catheterization. The pulmonary or systemic flow is evaluated from the diameter of the opening (d) and the velocity curve (ITV) recorded by pulsated Doppler in the aorta and the pulmonary artery; Q = d2/4 x ITV x heart rate both examinations (sonogram and catheterization) are performed in less than 24 hours. The results show a good correlation between both methods (R = 0.948) (Y = 0.756 X + 0.692). There is no significant variation between intra- or inter-observer. The findings of this study are comparable to those already published; the main difficulty in evaluating of the QP/QS by Doppler sonography are related to the measurement of the pulmonary diameter and there recording of good velocity curves. The QP/QS evaluated by Doppler sonography from a simplified calculation method advocated by Oloez et al. (QP/QS = d2 Ap x V max Ap/d2 Ao x V max Ao were compared, in retrospect, to the data provided by catheterization. The correlation is also satisfactory (R = 0.893). The Doppler ultrasonography is therefore a reliable and reproducible method in as far as the measurement of QP/QS in young or adults subjects affected with IAC OS.

The effect of flécaïnide (new class I antiarrhythmic) on ventricular rhythm troubles was studied in 24 patients using Holter's method. The following results were obtained. For ventricular tachycardia, two cases of suppression, three cases of distinct reduction in the number and duration of attack and one failure were recorded. For single ventricular extrasystoles, doublets and triplets, nine very good results (80 to 100 per cent reduction of arrhythmia) and four 50 to 80 per cent reductions in ventricular prematurity were obtained. Results were uncertain in two patients as the disappearance of extra-systoles was not followed by relapse after termination of treatment. There were three failures. A twenty-fifth patient was treated with flécaïnide IV followed by oral administration with uncertain results. Undesirable effects are infrequent and are often characterized by sinusal bradycardia. Blurred vision and paraesthesia were encountered. The principal biological parameters remained unchanged.

Results of arterial surveys on the basis of renal arteriograms in 100 consecutive unselected and hospitalized cases of lone arterial hypertension of the adult. Abnormal polar arteries with direct branching from the aorta were observed in 52 cases, combined with a stenosing or parnechymatous arterial anomaly in 7, quite isolated in 45 cases (61.8 percent of 73 cases). The very great incidence of abnormal polar arteries is a fundamental epidemiological datum of lone arterial hypertension of the adult.

Verapamil was initially known for its anti-angina effect. When given in higher doses, it displays pharmacologically unusual anti-arrhythmic effects, since it opens up a new path in this still limited category of drugs. Experience gained in 310 cases has enabled useful doses to be established and had shown that Verapamil is very effective in the management of supraventricular rhythm disturbances. Its high dose administration modality in patients with primary insufficiency and in the aged was also determined.

Intravenous adenosine proved effective in eight out of ten episodes of acute spontaneous supraventricular tachycardia. AV node blockade induced by adenosine occurred 20 s after injection, and disappeared very quickly. Side-effects were transient and never serious. Therefore, it is thought that adenosine can be proposed safely for the short-term treatment of supraventricular tachycardia. Because of the different mechanisms of action, the specific side-effects observed after ATP administration are unlikely to be encountered.

The cardiac electrophysiological effects of CERM 4205, a new cardioactive agent, were studied by means of intracardiac electrodes in man and in anaesthetized dogs. The results show that CERM 4205 is a cardioactive drug with a main inhibitory effect on slow-response structures (sinus and atrioventricular node) with an associated effect on fast-response structures (atrial, His-Purkinje and ventricular tissues). No qualitative differences were observed between the effects observed in man and dogs. In conclusion, the present study confirms that CERM 4205 is a compound with combined class IV and class I electrophysiological effects in dogs and man. The anaesthetized dog appears to be a satisfactory model for the evaluation of the electrophysiological effects of cardioactive drugs.

The electrophysiological effects of cibenzoline on the myocardium of the anesthetized dog were studied by the endocavitary catheter method. Plasma cibenzoline levels were measured throughout. The cibenzoline effects on the sinus rate were negligible. The corrected sinus recovery time was significantly prolonged only following chronic oral administration. Atrial refractory periods were significantly increased only at the fifth minute following acute intravenous administration and after chronic oral treatment. The intranodal conduction time (AH) and the refractory periods in atrio-ventricular node were slightly modified or not at all. On the other hand, intraventricular and His-Purkinje (HV) conduction times, ventricular refractory periods and QRS duration were strongly increased following acute or chronic administration. This would imply a principal effect on the rapid kinetics sodium entry current. Nevertheless, the very marked effect upon this current could, under the experimental conditions adopted, have masked a lesser action upon other membrane permeabilities, involved in other myocardial structures.

The purpose of this study was to find out whether non-invasive transoesophageal pacing could effectively replace right intra-atrial pacing for the indirect evaluation of sinus node and atrioventricular (AV) node function. In a population of 17 patients the corrected sinus node recovery time (CSRT), the atrio-sinu-atrial conduction time (ASACT) and Wenckebach's point (W) were calculated by intracavitary pacing, then by transoesophageal pacing. There was no significant difference between the two methods in pre-pacing sinus cycle. With right intra-atrial pacing, mean CSRT value was 365 +/- 54 ms (with 5 values greater than 520 ms), mean ASACT value was 229 +/- 29 ms (with 8 values greater than 220 ms), and W occurred at a mean cycle length of 425 +/- 29 ms. With transoesophageal pacing, mean CSRT value was 406 +/- 87 ms (with 5 values greater than 520 ms), mean ASACT value was 222 +/- 17 ms (with 8 values greater than 220 ms), and W occurred at a mean cycle length of 408 +/- 26 ms. The two methods correlated very closely for CSRT and W (r = 0.97) and relatively well for ASACT (r = 0.84). The number of CSRT and ASACT values regarded as prolonged was the same with the two methods; 84% of recorded (i.e. maximal) CSRT values occurred with the same length of pacing cycle. There was no statistically significant difference between the two methods in the calculation of CSRT and ASACT, but W occurred at a slightly shorter cycle (p less than 0.05) with transoesophageal pacing. Thus, transoesophageal pacins is a non-invasive, easy to perform method for indirect exploration of sinus node and AV node function in patients who do not require subnodal conduction studies.