Chemoembolization of symptomatic bone metastases: technical considerations and therapeutic effectiveness

Chemoembolization of bone metastases is defined by the intraarterial perfusion of a chemotherapy agent followed by microparticles embolization to improve tissue impregnation. This technique increases the local concentration of the chemotherapy agent. Tumor response (stable or reduced tumor size) is achieved in 30–80% of cases with symptomatic relief in over 80% of cases. The indications, technical considerations, and effectiveness of this procedure will be reviewed.     

Profil musculaire isocinétique du genou chez des sprinteurs et des sauteurs de haut niveau

Purpose

To study the isokinetic knee strength profile in elite sprinters and jumpers with recurrent hamstring injuries.

Method

A group of eight elite athletes including sprinters and jumpers with previous hamstring injuries were compared to a control group of non-injured players (n = 8). The concentric isokinetic knee flexion and extension strength was assessed at 60, 120 and 180 °/s using a Biodex^® System 3 dynamometer.

Results

There were no significant differences for any of the isokinetic variables comparing the injured and the non-injured athletes except for the hamstring to quadriceps ratio, which is lower in the control group. No significant difference was observed between the dominant and the non-dominant leg for the two groups.

Conclusion

Isokinetic muscle strength testing allows to detect the existence of a strength deficit after a hamstring injury during sports practice. Additional eccentric tests may be required to identify these cases.     

Guidelines for the performance of MRI in patients with cochlear implants

The number of patients with cochlear implant increases each year. Most of these patients may undergo MR imaging up to 1.5 Tesla, based on safety recommendations from each of the manufacturers. All external components should be removed for the examination. For three manufacturers providing about 85 % of all implanted devices in Europe, the internal components may be left in place and covered by an external bandage. Strict protocol guidelines must be implemented, especially head positioning in the magnet and within 30 cm from the bore opening. A single manufacturer, providing about 15 % of implanted devices, recommends surgical removal of the internal magnet prior to MR imaging.     

New techniques of tumor ablation (microwaves, electroporation)

Radiofrequency ablation is an image-guided technique of percutaneous tumor destruction using high frequency alternating current. Accuracy in needle placement and the selection of the imaging modality are key elements of the success of the procedure. The volume of ablation with a single needle insertion is limited to about 40 mm and the technique is most successful for tumors less than 3 cm in diameter with rapid decrease in efficacy for larger tumors. Tumors further away from large vessels are also more efficiently treated with this technique since heat loss from flowing blood in nearby vessels larger than 3 mm causes a four-fold increase in treatment failure. Under the best of circumstances (tumor less than 25 mm, away from vessels), RF ablation and surgical tumorectomy have respective failure rates of 6% and 7,3%. RF ablation of an isolated liver metastasis less than 4 cm in diameter results in survival rates at 1, 3 and 5 years of 97%, 84% and 40% respectively. In the liver, follow-up imaging is performed to detect residual tumor characterized by early enhancement. Thin peripheral enhancement (less than 1 mm) of the necrotic area and well-defined triangular shaped regions of enhancement are not signs of tumor recurrence but indicate the presence of inflammation or arterial to portal venous fistula. In the lung, an area of ground glass attenuation four times larger than the initial tumor is a predictive factor of success. PET-CT is the best imaging modality for follow-up of lung lesions following RF ablation.     

La sédentarité : un processus physio-psychologique et un facteur de risque pour la santé pour tous

Objectives

Taking into account the process of sedentarism (inclination to sedentary lifestyle) which leads the individual to no longer invest himself in physical activity (PA), despite being conscious of the deleterious character of this behaviour for health.

News

Considering the 3H syndrome (hypodynamy/hypokinesia/hypoxia) which is based on a functional approach of sedentary lifestyle, this article looks at its psycho-physiological interface. This model explains how from the alteration of the physiological capacity inherent to the lack of PA, the individual no longer wants to practice PA, and adopts attitudes and behaviours which are locking him in inactivity. This approach focuses on the importance of the modifications of aerobic capacity and of the feeling of dissatisfaction in the process of sedentary lifestyle.

Perspectives

This process is crucial to understand the phenomenon of over-handicap related to physical inactivity among people with disabilities and/or chronic pathologies.

Conclusion

The question of physical inactivity and/or sedentary lifestyle constitutes a major public health issue. The loss of aerobic capacity is the key element of this process. Recommendations are proposed to break this vicious circle of physical inactivity.     

Fluoroscopy-guided percutaneous biopsies: value of real-time guidance with image fusion software

Based on our preliminary experience with fluoroscopy-guided biopsy using a real-time 3D image fusion software, several biopsies may be performed in the interventional radiology suite as opposed to under CT guidance: percutaneous lung and bone biopsies are easily performed for lesions larger than 15 mm.     

Exploration détaillée des composantes de la glycorégulation chez des sportifs sujets aux hypoglycémies d’effort. Intérêt de l’oral minimal model

Context

Exercise hypoglycaemia (EH) is a very common yet little studied condition. It occurs in subjects with high values of insulin sensitivity (S_I) and glucose effectiveness (S_G), and is mainly triggered by dietary errors, over-training, or special circumstances (exposure to unusual temperatures, altitude, disruption of circadian rhythms).

Methods and results

We showed that S_I and S_G can be calculated from test meals by mathematical modelling (oral minimal model), whereas in athletes “surrogates” of S_I (HOMA, QUICKI, etc.) are misleading (not applicable in this area of high insulin sensitivity). These meals can also provide a comprehensive picture of the components of insulin secretion, which makes this exploration more informative. We studied the results obtained by this method in 19 athletes complaining of EH compared to 58 matched athletes not complaining from this problem. We observed higher values of S_I (P < 0.05) and S_G (P < 0.03), but overall, insulin secretion Φ_oral was similar. However, one of the components of insulin secretion, β-cell glucose sensitivity, is higher on the average (P < 0.04) because in 30% of cases it remains above the normal range for athletes, while remaining in the range for a normal population. Therefore, overall tolerance to carbohydrates (product Φ_oral × S_I) is higher (+58% P < 0.04).

Conclusion

Thus, these subjects have a powerful carbohydrate disposal, which is incompletely compensated by the expected homeostatic decrease in insulin secretion, especially with regard to β-cell glucose sensitivity.     

Condition physique et niveau d’activité physique d’adolescents présentant une déficience intellectuelle

Introduction

The aim of this study is to analyze the physical fitness and physical activity in adolescents with intellectual disabilities.

Summary of facts

These adolescents had a low level of physical fitness according to Eurofit test battery compared with standard results. Moreover, 41.18% of participants presented an excess of body fat mass and only 12% reach enough physical activity to avoid an excess of body fat.

Conclusion

This low physical fitness coupled with low levels of physical activity increases the health risks and might worsen restriction of social participation.     

Le point sur les recommandations de santé publique en matière d’activité physique

Objective

To describe the evolution of the recommendations for physical activity to better understand their scientific bases and to summarize the current public health recommendations for physical activity.

News

The health-related benefits from physical activity are well-known even if all the mechanisms are not well understood. Some recommendations have been published and guidelines have been provided.

Perspectives and projects

Public health recommendations for physical activity are largely shared. However, specific recommendations for management of chronic disease should be precised.

Conclusion

Recommendations for physical activity should be disseminate among professionals, and particularly among health professionals because of their capacity to deliver advices to their patients. The challenge consists in defining the optimal quantity and the type of physical activity according to the characteristics of the population and their health.     

Interventional radiology in oncology: inventory

A recent survey has compiled an inventory as complete as possible of the activities of interventional radiology in oncology in France. This overview has focused on identifying all invasive medical procedures whose aim was diagnosis and/or treatment of a tumor, which was carried out under guidance and under the control of an imaging means (RX, ultrasound, CT, MRI). If the biopsies represent more than half of the actions carried out under controlled imaging, recent years have seen the development of increasingly powerful therapeutic techniques.     

Application des opérateurs logiques (booléens) à la recherche bibliographique sur Internet en médecine du sport

Last year, use of logic operators (boolean system) was rarely possible on Internet, in sport medicine or anywhere. But from the beginning of 1997, many search motors on the Net create this possibility, although still with a certain syntax disparity.     

Interventional radiology in oncology in private practice

Interventional oncology in private practice requires expert training and can be performed in a stand-alone facility for type 1 procedures in a hospital setting for type 2 and 3 procedures where subspecialized radiologists, state-of-the-art equipment, and postprocedure hospital monitoring are available. A multidisciplinary effort with oncologists, internal medicine physicians and anesthesiologists is necessary. The practice of interventional oncology requires around the clock availability, meticulous and established protocols and procedures and a financial investment. On the other hand, it is professionally gratifying because of constant technical advances and the impact on patients.     

Facteurs de la variation de la fréquence cardiaque maximale: hypothèse «enképhalinique

To try to explain the decrease in maximal heart rate under different situations (ie, chronic hypoxia, ageing, proteino-energetic malnutrition), cardiac concentration and flow of leucine-encephalin peptide in isolated and perfused hearts were studied in rats. The heart leucine-encephalin concentration which was 301 ± 60 fmol/g before perfusion, increased up to 543 ± 125 fmol/g after perfusion (1 h). The total release during perfusion was four times the initial concentration. Concerning the antagonism of leucine-encephalin on cardiotropic adrenergic effects on isolated cardiomyocytes, it is possible to propose this mechanism to explain totally or partially the decrease in maximal heart rate under particular situations.     

CT-guided percutaneous biopsies

The number of biopsy requests continuously increases over the years. Similarly, lesions that are not amenable to CT-guided biopsy are exceptional due to improved imaging guidance and technical advances. The needle tract should preferably go through fat, which is less painful and safer. The biopsy should be painless with the use of local anesthetics complemented by intravenous sedation. Blunt introducers and hydrodissection techniques create access to lesions without injury to vessels, bowel loops and fascias. The biopsy samples should be processed in accordance with the suspected diagnosis.     

Prévention des lésions de l’appareil locomoteur liées à la pratique de l’athlétisme sur piste. Revue des données épidémiologiques

Objectives

Sports injuries have an important impact on the sport and in daily life. Although athletics is known and performed on five continents, few is known about epidemiological data such as frequency, incidence, diagnosis or risk factors of injuries in athletics. In this context, consideration on strategies of sports injury prevention in athletics should be conducted.

Current knowledge

Sports injury surveillance by epidemiological studies is a preliminary step necessary in the clinical research on sports injury prevention. This is permitted by an agreed and validated methodolgy. Currently, the musculoskeletal lesions related to the track and field practice are common. The great diversity of these lesions reflects the diversity of disciplines, the constraints are different between the explosive disciplines (sprints, hurdles, jumps, throws) and endurance disciplines (middle and long distance). There was a predominance of lesions of thigh and hamstrings in the disciplines of sprint/hurdles, the Achilles tendon in jumps and sprints/hurdles, and chronic knee injuries and stress fractures in middle-distance.

Conclusion

Preventive measures which target the most frequent pathologies should be introduced. However, these data appear insufficient to fully understand the specific injury according to disciplines, and to understand the risk factors and injury mechanisms. Therefore, prospective epidemiological studies, and studies focused on specific populations or pathologies, are needed to improve strategies for the prevention of injuries in track and field.     

Intra-arterial treatment of liver metastases from colorectal carcinoma

Colorectal carcinoma is a major public health concern with its yearly mondial incidence of about one million cases and yearly mortality of 500,000 cases. The liver is the organ most frequently affected by metastases with a frequency of 40 to 60% (contemporaneous in 25% of cases). While surgical resection is the only curative therapy, many patients are not such candidates due to the infiltrative nature of the liver metastases. Systemic chemotherapy and biotherapy regimens are the conventional treatment options for patients with multiple liver metastases. Under such circumstances, intra-arterial therapy may play a major role. We will review the main types of endovascular therapies for liver metastases from colorectal carcinoma including indications, results and potential complications.     

Effets de la reprise d’une activité physique régulière sur les capacités physiques et la qualité de vie d’hommes atteints du syndrome métabolique

Objective

To assess the effects of aerobic training on physical capacities and quality of life in men with metabolic syndrome (Mets), using field evaluation tools.

Synthesis

The physical capacities and the quality of life of eight men with Mets (59.5 ± 4.8 years old) was assessed before and after 8 weeks of aerobic exercise training by the 6 minutes walking test and the quality of life, obesity and dietetics scale.

Conclusion

Aerobic exercise training of 8 weeks improves physical capacities and the psychosocial impact dimension of quality of life in men with Mets, without generating anthropometric modification.     

Intérêt d’un réentraînement à l’effort intermittent individualisé chez l’adolescent obèse

Introduction

To assess in six obese teenagers, the effects of 30 sessions (three days/week) of 50-minute individualised interval training on cardiorespiratory and metabolic parameters at rest and during exercise.

Synthesis

After this programme, fat mass decreases (10.8%) while BMI did not change. The expiratory reserve volume improved (44.6%). Maximal aerobic power, oxygen pulse and maximal ventilation are higher (12.4%; 16.9%; 17.2% respectively). First and second ventilatory threshold are increased (26.1% and 17.3%).

Conclusion

This study demonstrates the efficiency of this individualised training programme for obese teenagers. Such a programme may therefore provides additional benefits in weight management of obesity.