Improvement of Radioimmunotherapy Using Pretargeting

During the past two decades, considerable research has been devoted to radionuclide therapy using radiolabeled monoclonal antibodies and receptor binding agents. Conventional radioimmunotherapy (RIT) is now an established and important tool in the treatment of hematologic malignancies such as Non-Hodgkin lymphoma. For solid malignancies, the efficacy of RIT has not been as successful due to lower radiosensitivity, difficult penetration of the antibody into the tumor, and potential excessive radiation to normal tissues. Innovative approaches have been developed in order to enhance tumor absorbed dose while limiting toxicity to overcome the different limitations due to the tumor and host characteristics. Pretargeting techniques (pRIT) are a promising approach that consists of decoupling the delivery of a tumor monoclonal antibody (mAb) from the delivery of the radionuclide. This results in a much higher tumor-to-normal tissue ratio and is favorable for therapy as well and imaging. This includes various strategies based on avidin/streptavidin-biotin, DNA-complementary DNA, and bispecific antibody-hapten bindings. pRIT continuously evolves with the investigation of new molecular constructs and the development of radiochemistry. Pharmacokinetics improve dosimetry depending on the radionuclides used (alpha, beta, and Auger emitters) with prediction of tumor response and host toxicities. New constructs such as the Dock and Lock technology allow production of a variety of mABs directed against tumor-associated antigens. Survival benefit has already been shown in medullary thyroid carcinoma. Improvement in delivery of radioactivity to tumors with these pretargeting procedures associated with reduced hematologic toxicity will become the next generation of RIT. The following review addresses actual technical and clinical considerations and future development of pRIT

Étude sur les complications précoces de la greffe pancréatique (apport de la tomodensitométrie)

Nous avons réalisé une étude rétrospective sur 141 greffes pancréatiques réalisées au CHU de Nantes entre le mois de janvier 2004 et février 2009. Nous avons étudié la population, le type de greffe, les complications survenues et leurs facteurs de risque ainsi que les tomodensitométries réalisées. Dans les quinze jours post-opératoires, 36,2% des patients ont présenté des complications post-chirurgicales dont 14 thromboses veineuses complètes, toutes responsables de la perte du greffon. La surcharge pondérale du donneur et dans une moindre mesure du receveur a été identifiée comme facteur de risque de survenue de ces thromboses. Parmi les modalités d imagerie, la tomodensitométrie avec injection de produit de contraste a semblé être la technique de choix d'exploration du greffon pancréatique. Cette injection n a pas eu d'impact majeur sur la fonction rénale de ces patients majoritairement greffés rénaux. L'analyse du délai de survenue des thromboses veineuses a permis de définir un délai de 3 jours pour la réalisation d'une tomodensitométrie de dépistage pour les patients à risque de thrombose.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Performance diagnostique du scanner abdominopelvien sans injection pour les douleurs abdominales aiguës chez la personne âgée

INTRODUCTION : La douleur abdominale aiguë chez le patient âgé constitue un enjeu diagnostique, en raison des difficultés cliniques rencontrées et des conséquences potentiellement graves de ces affections. L'Abdomen Sans Préparation étant un examen à faible rendement diagnostique dans ce domaine, l'objectif de notre étude était d'évaluer la performance diagnostique du scanner sans injection chez ces individus, groupe potentiellement à risque de néphropathie induite par les produits de contraste. MATERIELS ET METHODES : Etude rétrospective, monocentrique portant sur 100 patients de plus de 70 ans, admis pour douleur abdominale aiguë aux urgences du CHU de Nantes. Une double lecture des scanners a été réalisée indépendamment par 3 radiologues de compétences différentes. La première interprétation se limitait à la lecture du scanner sans injection, la seconde concernait l'examen complet. RESULTATS : La performance diagnostique du scanner abdominopelvien sans injection a été évaluée à 80 % pour les trois radiologues, indépendamment de leur niveau de compétence. Seuls 13 à 19 % des patients auraient été éligibles à un scanner sans injection. La concordance inter-observateur était de moyenne à bonne (kappa Cohen entre à 0,557 à 0,728). Seuls 0,05% (4 patients) ont présenté une néphropathie induite par les produits de contraste. CONCLUSION : La balance bénéfice/risque oriente vers l'injection compte- tenu de l'excellente performance reconnue du scanner injecté et de la faible incidence de la néphropathie induite aux produits de contraste.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

MOESM1 of Acute fissuration of a giant splenic artery aneurysm detected by point-of-care ultrasound: case report

Additional file 1: Video 1. POCUS scan of the left upper quadrant of a patient presenting with epigastric pain. See the vascular mass located between spleen and kidney

Migration of a contraceptive subcutaneous device into the pulmonary artery. Report of a case

The case is about an 18 year-old woman who benefited of a radiopaque contraceptive implant (Nexplanon) inserted in the left arm. When she wanted to remove it, it couldn't be found by palpation, US, CT and MRI. A CXR and a thoracic CT scan were necessary to locate the implant, and the implant was removed by endovascular procedures.Significant migration of a contraceptive implant is uncommon, and only one case of migration far from the insertion limb has been reported. Using radiopaque contraceptive implants like Nexplanon could locate them easier if a migration occurs. Keywords: Migration of contraceptive implant, Foreign bod

Deep Learning Models for Low Dose CT Simulation

International audienc

Successful percutaneous thrombolysis and aspiration thrombectomy for graft salvage after pancreas transplant venous thrombosis

International audienc

Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial

Abstract Background Abdominal pain is common in patients visiting the emergency department (ED). The aim of this study was to assess the diagnostic contribution of point-of-care ultrasound (POCUS) in patients presenting to the ED with acute abdominal pain. Methods We designed an interventional randomized, controlled, open label, parallel-group, trial in two French EDs. We included adult patients presenting to the ED with acute abdominal pain. Exclusion criteria were a documented end-of-life, an immediate need of life-support therapy and pregnant or breast-feeding women. Patients were randomized in the experimental group (i.e., workup including POCUS) or control group (usual care). The primary objective of the study was to assess the added value of POCUS on diagnostic pathway in the ED, according to the diagnostic established a posteriori by an adjudication committee. The primary endpoint was the proportion of exact preliminary diagnosis between the 2 groups. The preliminary diagnosis made after clinical examination and biological results with POCUS (intervention arm) or without POCUS (usual care) was considered exact if it was similar to the adjudication committee diagnosis. Results Between June 2021 11th and June 2022 23th, 256 patients were randomized, but five were not included in the primary analysis, leaving 125 patients in the POCUS group and 126 patients in the usual care group (130 women and 121 men, median [Q1-Q3] age: 42 [30;57]). There was no difference for exact diagnosis between the two groups (POCUS 70/125, 56% versus control 78/126 (62%), RD 1.23 [95% CI 0.74–2.04]). There was no difference in the accuracy for the diagnosis of non-specific abdominal pain nor number of biological or radiological exams. Diagnostic delays and length of stay in the ED were also similar. Conclusions In this trial, systematic POCUS did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED with acute abdominal pain. However, as it was a safe procedure, further research should focus on patients with suspected etiologies where POCUS is particularly useful. Trial registration: This trial was registered on ClinicalTrials.gov on 2022/07/20 ( https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1 ) (NCT04912206)