Experience du service de medecine nucleaire sahloul sousse dans la prise en charge des carcinomes differencies de la thyroïde a thyroglobuline elevee.

But : L’objectif de notre travail est de présenter notre expérience dans la prise en charge des cancer différencié de la thyroïde (CDT) à Thyroglobuline (Tg) élevée, tout en identifiant les paramètres modifiant l’efficacité de l’Irathérapie et la valeur seuil de la Tg permettant avec un balayage post thérapeutique négatif de conclure à une rémission.Matériels et méthodes : Il s’agit d’une étude rétrospective portant sur 150 patients opérés pour CDT, suivis entre 1990 et 2006 et présentant une Tg>2ng/ml.Résultats : Il s’agit de 122 femmes et 28 hommes. L’âge moyen était de 52 ans. La Tg ne dépendait pas du type histologique mais il existait une relation statistiquement significative entre la Tg et la taille tumorale, l’atteinte ganglionnaire, l’extension locorégionale, la présence de métastases et le stade TNM. La réponse thérapeutique des CDT avec une Tg élevée dépendait de l’âge des patients, des caractéristiques anatomopathologiques de la tumeur et des valeurs de la Tg.Conclusion : L’efficacité ablative est optimisée par des cures d’iode 131 qui doivent être prolongées tant que la Tg reste élevée. La surveillance à vie, au cours de la quelle on exige des seuils de Tg infèrieurs à 2ng/ml, est nécessaire. Mots clés : Cancers différenciés de la thyroide, Thyroglobuline, Irathérapie, Pronostic, Surveillance.Purpose: The aim of our work is to present our experience in the management of differentiated thyroid cancer (DTC) with high thyroglobulin (Tg) , to identify parameters changing iodine effectiveness and Tg threshold with negative post treatment scan conclude to remission.Materials and Methods: This is a retrospective study of 150 patients undergoing CDT, followed between 1990 and 2006 and having a Tg > 2ng/ml .Results: Our study concerns 122 women and 28 men. The average age was 52 years . Tg value does not depend on the histological type but there was a statistically significant relationship between Tg and tumor size, lymph node involvement, locoregional , metastasis and TNM stage . The therapeutic response of CDT with a high Tg was dependent on the age of patients, the pathological characteristics of the tumor and the Tg values ofConclusion: The ablative efficiency is optimized by 131 cures iodine should be extended until the Tg remains high. Monitoring life is necessary and the thresholds Tg below 2ng/ml is required.Keywords: Differentiated thyroid Cancers, Thyroglobulin, Iodine 131, Prediction, Monitoring

Lymphome t/nk primitif du larynx : localisation inhabituelle de lymphome extranodal

Nous rapportons un cas de lymphome extranodal T/Nk primitif du larynx. il s’agit d’un patient âgé de 22 ans qui s’était présenté pour une dysphonie chronique associée à une dyspnée inspiratoire. une chimiothérapie protocole SMiLE avec radiothérapie ont été institués avec obtention d’une rémission complète. Huit mois plus tard, le patient présentait une récidive de la tumeur avec un oedème palpébral et une obstruction du canal lacrymonasal. L’évolution a été fatale suite à une aspergillose invasive en cours de chimiothérapie.Mots clés : lymphome, larynx.A rare case of primary laryngeal T/Nk- cell lymphoma, nasal type is reported. The patient was 22-year old male who presented with dysphonia, dyspnea. Chemotherapy protocol SMiLE and radiotherapy were instituted with complete remission of the tumor. Eight months afterward, he presented with tumor recurrence, palpebral edema, obstruction of the lacrymonasal duct. He died within few days with invasive aspergillosis while he was receiving chemotherapy SMiLE regimen.Keyswords : lymphoma, larynx

Impact of COVID-19 pandemic on cardiovascular testing in Asia: the IAEA INCAPS-COVID study

BACKGROUND The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. OBJECTIVES This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. METHODS The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. RESULTS Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. CONCLUSIONS The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted

International Impact of COVID-19 on the Diagnosis of Heart Disease

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified.OBJECTIVES The study sought to assess COVID-19`s impact on global cardiovascular diagnostic procedural volumes and safety practices.METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained.RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoradc echocardiography decreased by 59%, transesophageat echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). hi multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and teteheatth.CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Positron-emission tomography-guided radiation therapy: Ongoing projects and future hopes

International audienceRadiation therapy has undergone significant advances these last decades, particularly thanks to technical improvements, computer science and a better ability to define the target volumes via morphological and functional imaging breakthroughs. Imaging contributes to all three stages of patient care in radiation oncology: before, during and after treatment. Before the treatment, the choice of optimal imaging type and, if necessary, the adequate functional tracer will allow a better definition of the volume target. During radiation therapy, image-guidance aims at locating the tumour target and tailoring the volume target to anatomical and tumoral variations. Imaging systems are now integrated with conventional accelerators, and newer accelerators have techniques allowing tumour tracking during the irradiation. More recently, MRI-guided systems have been developed, and are already active in a few French centres. Finally, after radiotherapy, imaging plays a major role in most patients' monitoring, and must take into account post-radiation tissue modification specificities. In this review, we will focus on the ongoing projects of nuclear imaging in oncology, and how they can help the radiation oncologist to better treat patients. To this end, a literature review including the terms "Radiotherapy", "Radiation Oncology" and "PET-CT" was performed in August 2019 on Medline and ClinicalTrials.gov. We chose to review successively these novelties organ-by-organ, focusing on the most promising advances. As a conclusion, the help of modern functional imaging thanks to a better definition and new specific radiopharmaceuticals tracers could allow even more precise treatments and enhanced surveillance. Finally, it could provide determinant information to artificial intelligence algorithms in "-omics" models