Imagerie protonique pour la protonthérapie : état de l’art

Proton therapy allows a highly precise tumour volume irradiation with a low dose delivered to the healthy tissues. The steep dose gradients observed and the high treatment conformity require a precise knowledge of the proton range in matter and the target volume position relative to the beam. Thus, proton imaging allows an improvement of the treatment accuracy, and thereby, in treatment quality. Initially suggested in 1963, radiographic imaging with proton is still not used in clinical routine. The principal difficulty is the lack of spatial resolution, induced by the multiple Coulomb scattering of protons with nuclei. Moreover, its realization for all clinical locations requires relatively high energies that are previously not considered for clinical routine. Abandoned for some time in favor of X-ray technologies, research into new imaging methods using protons is back in the news because of the increase of proton radiation therapy centers in the world. This article exhibits a non-exhaustive state of the art in proton imaging.     

A case of napkin ring calcification of aorta following traumatic transection

The case demonstrates a hitherto undescribed phenomenon of a case of survival following an acute aortic syndrome without surgical intervention.     

Studies of novel variants associated with Hb F in Sardinians and Tanzanians in sickle cell disease patients from Cameroon

High level of Hb F has been shown to improve survival in sickle cell disease. Among 453 Cameroonians with sickle cell disease, we have investigated 18 selected single-nucleotide polymorphisms (SNPs) in novel and suggestive loci associated with Hb F level identified through a genomewide association study in sickle cell disease patients in Tanzania, and whole-genome sequencing of a population from Sardinia. Seven of 10 variants reported in Sardinians were either monomorphic or very rare in the Cameroonians. No associations were observed with any SNPs and Hb F levels in Cameroonians affected by sickle cell disease. The present study illustrates the complexity of replicating Hb F-promoting variants association results across populations.     

Transient Blindness in Pre-Eclakpsia: Two Cases and A Review of the Literature

Two patients with severe pre-eclampsia in the third trimester of pregnancy developed sudden blindness. Physical examination and computed tomography indicated a central cause, most likely cerebral edema. Swan-Ganz catheterisation revealed a low cardiac preload and a markedly elevated afterload. Following pharmacologic reduction of the afterload the blindness disappeared completely.

On the basis of the two cases presented and a review of the pertinent literature we conclude that temporary cortical blindness in patients with severe pre-eclampsia may usually be attributed to focal cerebral edema. It seems likely that a combination of high cerebral arterial pressure, leading to disruption of capillary tight junctions, with an elevated interstitial cerebral colloid osmotic pressure constitutes the main determinant of fluid leakage into cerebral tissue. Treatment should consist of gradual pharmacologic reduction of mean arterial blood pressure.     

Pulmonary fibrolysis in a patient with idiopathic pulmonary fibrosis: improvement of clinical and radiological pattern after treatment with pirfenidone

Idiopathic Pulmonary Fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia associated with the histologic and/or radiologic pattern of usual interstitial pneumonia (UIP). Nowadays, the high‐resolution computed tomography pattern of “definite UIP” is enough to define a diagnosis of UIP without histological proof. This is pivotal especially in elderly patients with comorbidities. Early recognition of IPF is relevant for its prognostic implication. Some pharmacological strategies have been proposing novel molecules that tend to slow lung function decline, even though without healing fibrosis. We report a case of ex‐heavy smoker male with IPF showing clinical and radiological improvement after 11 months of treatment with Pirfenidone. The definite diagnosis was challenging and it was reached by a multidisciplinary approach.