Predictive factors of acute urinary morbidity after iodine-125 brachytherapy for localised prostate cancer: a phase 2 study.

PURPOSE: To analyse predictive factors of acute urinary morbidity after transperineal permanent prostate brachytherapy. METHODS AND MATERIALS: Sixty patients treated in a phase 2 study with iodine-125 brachytherapy (9/1998 to 2/2000) for localised prostate adenocarcinoma were analysed after at least 1-year follow-up. Prescribed dose was 144 Gy and all patients had a pre-planning and a post-implant dosimetry. Urinary morbidity was evaluated prospectively using the Radiation Therapy Oncology Group (RTOG) scale. We examined the relationship between pre-implant ultrasound prostate volume, post-implant CT-scan prostate volume, neoadjuvant hormonotherapy, total number of needles and seeds, post-implant dosimetry variables, first 30 vs. last 30 treated patients and post-implant urinary morbidity. RESULTS: All patients experienced some degree of urinary distress symptoms after treatment. Symptoms were generally mild grade 1 in 56% and grade 2 in 10% lasting less than 6 months. Eight patients (13%) required bladder catheter for acute urinary obstruction. At 1-year follow-up, nine patients (15%) complained from persistent dysuria requiring in three cases endoscopic prostate resection. The percentage of urethra volume receiving 216 Gy (cut-off 40%) and the pre-implant prostate volume (cut-off 31 ml) were the only statistically significant predictor of grade 2-3 or persistent urinary morbidity on multivariate analysis. CONCLUSION: Our short-term data suggest that both pre-implant prostate volume value and post-implant V.U. 150 value might be predictors for urinary morbidity after prostate brachytherapy.     

Ophthalmologic evaluation at the age of 2 years of newborn infants hospitalized in the neonatology center at Rennes

The eyes of 1 466 children (88.3% of the total) who were admitted to the Centre for premature babies and the neonatal intensive care unit at Rennes between 1973-1975 were re-examined at the age of 2 years. There were 839 premature and 226 term babies whose weight was appropriate for gestational age, and 74 premature and 327 term babies who were small for dates. 95 (6.5%) had eye disorders at the age of 2. Abnormalities were more common in infants with a Birth weight of less than 1 500 g and in those with a gestional age of less than 28-30 weeks. Boys were more commonly affected than girls. 38% of the children with eye disorders had other problems of which the commonest was mental retardation (75%). There was no relation between perinatal complication and the incidence of eye disorders. The most common abnormality was squint (94%) but other problems were major (blindness, cataracts, retrolental fibroplasia). 37% of the abnormalities had not been diagnosed until found in the survey at the age of 2 years.     

Comprehensive PKD1 and PKD2 Mutation Analysis in Prenatal Autosomal Dominant Polycystic Kidney Disease

Prenatal forms of autosomal dominant polycystic kidney disease (ADPKD) are rare but can be recurrent in some families, suggesting a common genetic modifying background. Few patients have been reported carrying, in addition to the familial mutation, variation(s) in polycystic kidney disease 1 (PKD1) or HNF1 homeobox B (HNF1B), inherited from the unaffected parent, or biallelic polycystic kidney and hepatic disease 1 (PKHD1) mutations. To assess the frequency of additional variations in PKD1, PKD2, HNF1B, and PKHD1 associated with the familial PKD mutation in early ADPKD, these four genes were screened in 42 patients with early ADPKD in 41 families. Two patients were associated with de novo PKD1 mutations. Forty patients occurred in 39 families with known ADPKD and were associated with PKD1 mutation in 36 families and with PKD2 mutation in two families (no mutation identified in one family). Additional PKD variation(s) (inherited from the unaffected parent when tested) were identified in 15 of 42 patients (37.2%), whereas these variations were observed in 25 of 174 (14.4%, P=0.001) patients with adult ADPKD. No HNF1B variations or PKHD1 biallelic mutations were identified. These results suggest that, at least in some patients, the severity of the cystic disease is inversely correlated with the level of polycystin 1 function.     

Intracellular calcium variations evoked by mechanical stimulation of mammalian isolated vestibular type I hair cells

The variations of intracellular free calcium concentration ([Ca²⁺]_i) were recorded on-line from guinea-pig isolated vestibular sensory cells using a fura-2 fast fluorescent photometry system, during mechanical displacements of the hair bundle. Repetitive displacements of the hair bundle towards the kinocilium (positive stimulation 7°, 300 ms, 2Hz for 10 s), revealed [Ca²⁺]_i variations detectable only in the cuticular plate. [Ca²⁺]_i increased from 105 to 145 nM. Single mechanical displacements of the hair bundle (7°, 200 ms, 0.5Hz) evoked increases of [Ca²⁺]_ifrom 50±23 nM to 139±79 (n=12). In the opposite direction, the mechanical stimulations (8°, 400ms, 0.5Hz) evoked a decrease of [Ca²⁺]_i from 68±17 nM to 37±12 nM (n= 8). The variations of [Ca²⁺]_i detected in the cuticular plate during positive displacements of the hair bundle were reversibly abolished in the presence of 100 M gentamicin and they could not be evoked in 0.1 mM calcium in the external medium. From these experiments, it has been concluded that the [Ca²⁺]_i variations recorded in the cuticular plate were due to a limited entry of calcium ions through transduction channels localized in the hair bundle. The typical kinetics of variations of [Ca²⁺]_i evoked during positive displacements of the hair bundle should account for the presence of strong calcium regulation systems in the hair bundle and cuticular plate.     

Infantile mortality in Ile-et-Vilaine (1970-1986)

The rates and the causes of infantile mortality between 1970 and 1986 in the district of Ille-et-Vilaine are reported. During that period, infantile mortality rate decreased from 18.7 to 7.06% and from 12.4 to 3.6% during the first week (0-6 days), thereby suggesting the efficacy of medical care programs for this pediatric age group in France. Since 1980, with more accurate record keeping, using the recommended international classifications, there is a relative stagnation in the rate or early neonatal deaths (3.97 to 3.67) as compared to a sizable drop in the rates of late neonatal deaths (1.90 to 0.73) and post neonatal deaths (4.63 to 2.57). Congenital abnormalities have become the most important cause of death (34%) before prematurity (24.58%). However, the number of congenital anomalies should quickly decrease with prenatal screening programs leading to interruption of pregnancies. Although the percentage of infantile deaths due to prematurity has decreased from 66% between 1970 and 1974 to 24.58% in recent years, prematurity remains an important cause of death. Infections have decreased and the Sudden Infant Death Syndrome is currently the most important cause of death during the postneonatal period. The well known factors of risks are confirmed and particularly increased vulnerability of the population with a low socio-economic status which should lead to appropriate prevention programs. Despite these very impressive results, birth remains the most vulnerable period of life and current efforts should continue. Priority must be given to the improvement of prenatal care which requires good ongoing collaboration between obstetrics and pediatrics and the use of the Maternity Health Booklet.