Whole breast and regional nodal irradiation in prone versus supine position in left sided breast cancer

Background: Prone whole breast irradiation (WBI) leads to reduced heart and lung doses in breast cancer patients receiving adjuvant radiotherapy. In this feasibility trial, we investigated the prone position for whole breast + lymph node irradiation (WB + LNI). Methods: A new support device was developed for optimal target coverage, on which patients are positioned in a position resembling a phase from the crawl swimming technique (prone crawl position). Five left sided breast cancer patients were included and simulated in supine and prone position. For each patient, a treatment plan was made in prone and supine position for WB + LNI to the whole axilla and the unoperated part of the axilla. Patients served as their own controls for comparing dosimetry of target volumes and organs at risk (OAR) in prone versus in supine position. Results: Target volume coverage differed only slightly between prone and supine position. Doses were significantly reduced (P < 0.05) in prone position for ipsilateral lung (Dmean, D2, V5, V10, V20, V30), contralateral lung (Dmean, D2), contralateral breast (Dmean, D2 and for total axillary WB + LNI also V5), thyroid (Dmean, D2, V5, V10, V20, V30), oesophagus (Dmean and for partial axillary WB + LNI also D2 and V5), skin (D2 and for partial axillary WB + LNI V105 and V107). There were no significant differences for heart and humeral head doses. Conclusions: Prone crawl position in WB + LNI allows for good breast and nodal target coverage with better sparing of ipsilateral lung, thyroid, contralateral breast, contralateral lung and oesophagus when compared to supine position. There is no difference in heart and humeral head doses

Questionnaire pour évaluation à distance des prothèses articulaires de hanche et de genou : mise en pratique pour le suivi et la détection des complications. Etude comparative sur une année complète.

International audienc

Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement

International audienceIntroductionThe aim of the present study was to assess our management of infected total hip replacement in indications for 2-stage surgical treatment according to current guidelines when a cement spacer has been used. The study hypothesis was that the complications rate related to cement spacers is low.Material and methodA single-center retrospective study included 26 patients receiving a spacer between the two stages of total hip replacement, over a 5 year period. We analyzed the spacers used, mechanical complications, infectious complications and the second stage of surgery.ResultsDuring the interval between surgeries, in the 26 patients, there were 19 spacer-related mechanical complications (73% of patients): 11 dislocations (42.3%), 5 spacer fractures (19.2%), 5 femoral bone lyses or fractures (19.2%) and 3 acetabular lyses or fractures (11.5%). In 4 cases, complications were associated. The greater the femoral offset of the spacer, the more frequent were femoral bone lyses or fractures (p = 0.05), and the smaller the offset the more frequent were acetabular lyses or fractures (p = 0.05). The rates of mechanical complications (p = 0.003) and spacer fracture (p = 0.02) were significantly greater in older patients. There were 4 cases of reinfection (19%): i.e., an 81% treatment success rate. One reinfection implicated a new bacterium: methicillin-susceptible Staphylococcus aureus. The second surgical stage was significantly longer in complex bipolar revision (p = 0.009).ConclusionThe present results showed a high risk of spacer-related complications, and thus the importance of selection of patients liable to derive real benefit and those for whom a Gilderstone procedure would be preferable

Transcatheter aortic valve thrombosis: Data from a French multicenter cohort analysis

International audienc

A metal-binding site in the catalytic subunit of anaerobic ribonucleotide reductase

A Zn(Cys)(4) center has been found in the C-terminal region of the crystal structure of the anaerobic class III ribonucleotide reductase (RNR) from bacteriophage T4. The metal center is structurally related to the zinc ribbon motif and to rubredoxin and rubrerythrin. Mutant enzymes of the homologous RNR from Escherichia coli, in which the coordinating cysteines, conserved in almost all known class III RNR sequences, have been mutated into alanines, are shown to be inactive as the result of their inability to generate the catalytically essential glycyl radical. The possible roles of the metal center are discussed in relationship to the currently proposed reaction mechanism for generation of the glycyl radical in class III RNRs