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Resume Introduction Aujourd’hui, la cryotherapie fait partie de l’arsenal therapeutique face au cancer de la prostate localise. Nous nous sommes interesses aux traitements globaux, de premiere ou de seconde ligne. Notre travail visait a identifier des facteurs de risques de mauvaise reponse au traitement du cancer de la prostate par cryotherapie. Materiels et methodes De juillet 2009 a juillet 2012, 18 patients ont ete traites par cryotherapie pour un cancer de prostate localise. Il s’agissait respectivement de traitement de premiere et de seconde ligne pour 12 et 6 des patients. Nous avons analyse les PSA post-cryotherapie selon les criteres PHOENIX et ASTRO definissant la recidive biologique d’une part ; et les recidives confirmees histologiquement d’autre part. Nous avons compare les donnees pre- et postoperatoires des patients en recidives histologiques. Resultats Il y avait 2 (11 %) recidives biologiques et 7 (38,9 %) recidives histologiques. La moyenne de recidive histologique post cryotherapie etait de 20,7 (± 13,9) mois. Le traitement de seconde intention (p = 0,5) ; le PSA pre-cryotherapie (p = 0,2), le score de Gleason/ISUP pre-cryotherapie (p = 0,4) n’etaient pas des facteurs de recidive. Le pourcentage de biopsies positives avant cryotherapie etaient de 25 % (± 16,5) dans le groupe sans recidive contre 40,7 % (± 25,2) dans le groupe avec recidive, et le pourcentage de cancer sur les biopsies positives avant cryotherapie etaient de 10,6 % (± 9,3) dans le groupe sans recidive contre 18,7 % (± 16,5) dans le groupe avec recidive ; semblaient etre des facteurs de recidives (p = 0,09 et p = 0,3) sans etre significatif en raison d’un manque de puissance de l’etude. Le caractere bilateral des biopsies etait significatif (p = 0,04). Conclusion Le caractere bilateral des biopsies apparait comme un facteur de risque de recidive, les pourcentages eleves de biopsies positives ainsi que de cancer sur les longueurs totales de biopsies semblent etre des facteurs de risque de recidive apres cryotherapie de premiere ou de seconde ligne, bien que les resultats soient non significatifs. La definition de recidive biologique post cryotherapie reste a definir. Niveau de preuve 4.

Resume Introduction Les fuites chyleuses sont des situations cliniques peu frequentes, souvent d’origine iatrogenique post-chirurgicale. Le chylothorax est le type le plus courant de fuite chyleuse entrainant un epanchement pleural necessitant un drainage percutane. Les fuites chyleuses se compliquent souvent d’une immunodepression, d’un desequilibre hydro-electrolytique et d’une perte nutritionnelle. Au cours des dernieres annees, l’embolisation du canal thoracique realisee apres une lymphangiographie diagnostique percutanee a enrichi l’arsenal therapeutique disponible pour le traitement des fuites chyleuses, et notamment du chylothorax. Messages principaux Dans notre serie institutionnelle, le succes clinique etait de 77 % et aucune complication precoce ou a moyen terme n’a ete notee, ce qui est conforme aux donnees de la litterature faisant etat d’un succes clinique variant entre 52 et 74 % et de complications precoces ou a moyen terme variant entre 0 et 3 %. En accord avec ces donnees, l’embolisation du canal thoracique est ainsi devenu le traitement standard du chylothorax refractaire a une prise en charge medicale conservatrice. Par ailleurs la lymphangiographie diagnostique percutanee telle que realisee avant l’embolisation du canal thoracique permet de mieux comprendre le systeme lymphatique, ouvrant ainsi la voie a de nouvelles approches diagnostiques et therapeutiques dans divers contextes cliniques, notamment l’insuffisance cardiaque congestive, les maladies hepatiques et auto-immunes, les lymphoceles et les therapies oncologiques par cellules CAR-T. Conclusion La lymphangiographie percutanee avec embolisation du canal thoracique est un traitement peu invasif, sur et efficace des fuites chyleuses iatrogenes refractaires au traitement medical.

Resume La thrombectomie mecanique est devenu le traitement de reference des infarctus cerebraux par occlusion proximale, en limitant le handicap. Dans certaines situations, l’utilisation de la voie femorale est difficile, voire impossible, et d’autres acces tels que la voie radiale permettent de pallier cette limite. Nous illustrons ici cette technique a travers du cas d’une patiente de 62 ans, obese (IMC = 48,5 kg/m2), chez qui la voie radiale droite a ete choisie pour la realisation d’une thrombectomie pour une occlusion proximale de l’artere cerebrale moyenne droite. Un « stent-retriever » a ete utilise via un catheter a ballonnet 6 French positionne au niveau de la carotide interne, et une reperfusion cerebrale complete a ete obtenu en 2 passages 34 minutes apres la ponction radiale. Cette approche apparait interessante dans certaines situations ou la voie femorale est compliquee (echec de la ponction femorale, catheterisme par voie femorale impossible).

AIM To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation. MATERIALS AND METHODS Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7±4.4 [SD] years; range 27–84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively. RESULTS Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2±1.7 (SD), and dropped significantly to 3.5±1.8 (SD), 1.9±1.7 (SD), and 1.9±1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5±23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported. CONCLUSION Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control.

Purpose To investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (> 70 °C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control. Materials and methods Thirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4 ± 10.5 (SD) years (range: 40–78 years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed. Results Metastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4 ± 3.5 (SD) °C (range: 70–90 °C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving b-RFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4 ± 2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0 ± 4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8 ± 4.8 [SD] months). Conclusions B-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor.

International audience; Aim: To report the technique of percutaneous double oblique anterior access to the acetabulum and evaluate its feasibility and safety.Materials and methods: Pelvic computed tomography (CT) examinations of 60 patients (30 men and 30 women; mean age 62.6±13.2 years) were retrieved randomly from the picture archiving and communication system (PACS). A virtual intraosseous trajectory was defined on both sides on the axial CT images with the entry point marked 1 cm above the anterosuperior iliac spine and the endpoint defined just above the level of the ischial spine at the midpoint of the posterior acetabulum. Patient age, sagittal oblique angulation, axial oblique angulation, length of intraosseous trajectory, distance from the hip joint, thickness of the iliac bone cortex, and intervening structure(s) between the skin and the bone entry points were recorded.Results: The mean sagittal and axial oblique angulations were 34.2±4.5° and 31.5±6.7°, respectively, and mean length of the intraosseous trajectory was 11.8±0.9 cm. The axial oblique angle and length of the intraosseous trajectory were significantly lower in the female than the male population (p

To determine the pejorative predictive factors on oncologic outcomes of percutaneous MR-guided whole gland prostate cancer cryoablation (CA).Medical records of patients treated from 2009 to 2012, to assess medium-term oncologic outcomes, were reviewed. Prostate biopsies were performed in local recurrence suspicion (biochemical failure, MR follow-up failure).Among 18 patients, mean age of 72.6 (61-78), 2 (11 %) and 7 (38.9 %) biological and reported biopsy-proven local recurrence respectively with our initial technic of CA. Mean follow-up and recurrence were 56.3 (±21.7) and 20.7 (±13.9) months respectively. A previous treatment of prostate cancer (P=0.5), pre-treatment PSA (P=0.2), pre-treatment Gleason/ISUP score (P=0.4), nadir PSA post-CA (P=0.22) were not associated with recurrence. Bilateral positive cores appears as a pejorative predictive factor (P=0.04). However mean pre-treatment positive cores percentage, 25 (±16.5) in responding patients versus 40.7 (±25.2) in case of recurrence, and maximum percentage of cancer extent in each positive core, 10.6 (±9.3) in responding patients versus 18.7 (±16.5) in case of recurrence, seemed associated with local recurrence after prostate CA but our analysis wasn't able to find a difference (P=0.09 and P=0.3 respectively) due to a lack of power.Bilateral positive cores appears as a pejorative predictive factor. In our experience, important tumor volume seem to be a pejorative predictive factor for oncologic outcomes after PCA whereas treatment, PSA, Gleason/ISUP score, nadir PSA are not.4.

AIM To assess the value and efficacy of real-time shear-wave elastography (SWE) of normal testicular parenchyma and various common testicular diseases in clinical practice. MATERIALS AND METHODS SWE was undertaken in 338 patients (mean age: 43.2±17.2 years, range 17–78 years) comprising normal testicles (n = 358), testicular microlithiasis (n = 40), and various testicular diseases (n = 208) and the stiffness was recorded. The final diagnosis was correlated with the clinical context, long-term follow-up, or histopathology. Statistical evaluation was performed to provide a stiffness threshold for pathological diagnosis. RESULTS The mean size of testicular lesions was 2.6±1.5 cm (range: 10–42 mm). The mean Young's modulus value for normal testis was recorded at 4.55±2.54 kPa. Whatever the stage of microlithiasis, a higher statistically significant stiffness value was recorded. For acute orchitis, the mean stiffness value was slightly higher, but not statistically significantly. The testicular tumoural processes presented a median stiffness value of 21.02 kPa with a cut-off of 16.1 kPa. Fibrosis presented the highest median stiffness value of 30.03 kPa with a cut-off of 26.3 kPa. By analysing the distribution of the different pathological groups, the difference was statistically significant between fibrosis and tumoural processes (p = 0.001). CONCLUSION SWE is a feasible technique in the exploration of the testicular parenchyma. SWE values can be used to differentiate testicular fibrosis from a tumoural process with confidence.

Objectifs Le syndrome de cutis laxa est une affection dermatologique rare pouvant etre hereditaire ou acquise. Elle est la consequence d’une destruction des fibres elastiques (elastolyse) qui se trouvent dans la peau, mais aussi dans les poumons, les valves cardiaques et les vaisseaux notamment. Nous rapportons l’observation d’une cutis laxa acquise dans un contexte de gammapathie monoclonale, compliquee d’une aortite, situation exceptionnelle voire inedite. Materiels et methodes Nous rapportons le cas d’un homme de 45 ans ayant developpe un syndrome de cutis laxa acquis (confirme histologiquement par biopsie cutanee), secondaire a une gammapathie monoclonale de signification indeterminee, complique d’une dystrophie emphysemateuse severe ayant necessite une greffe bi-pulmonaire. Au cours de son bilan pre-greffe, le patient a eu deux examens TEP/TDM au FDG objectivant la progression d’une aortite thoracique, s’etendant a l’abdomen et aux troncs supra-aortiques, ainsi qu’aux troncs pulmonaires. Resultats L’examen histopathologique realise sur les pieces d’exerese de la greffe pulmonaire confirme la presence d’alterations parietales vasculaires des arteres pulmonaires compatibles avec un syndrome de cutis laxa. Une troisieme TEP/TDM de reevaluation post-greffe sous corticoides et immunomodulateurs a montre une regression partielle de l’atteinte de l’aorte thoracique ascendante et des troncs supra-aortiques, ainsi qu’une regression quasi-complete de l’atteinte de l’aorte thoracique descendante et de l’aorte abdominale. Il n’existe pas d’atteinte inflammatoire des arteres pulmonaires heterologues alors que le tronc pulmonaire natif est encore moderement hypermetabolique. Conclusions Le syndrome de cutis laxa est une affection dont les complications systemiques sont variees. Concernant ce patient, l’exploration TEP/TDM au FDG a permis de mettre en evidence un hypermetabolisme des gros vaisseaux infraclinique etendu et extensif. Le diagnostic precoce de ce type de complication inflammatoire pourrait presenter un interet pronostique dans la prise en charge du patient.