Annabelle Stainier

Magnetic Resonance Imaging of the Axial Skeleton for Detecting Bone Metastases in Patients With High-Risk Prostate Cancer: Diagnostic and Cost-Effectiveness and Comparison With Current Detection Strategies

PURPOSE To evaluate the diagnostic performance, costs, and impact on therapy of one-step magnetic resonance imaging (MRI) of the axial skeleton (MRIas) for detecting bone metastases in patients with high-risk prostate cancer (PCa). PATIENTS AND METHODS Sixty-six consecutive patients with high-risk PCa prospectively underwent MRIas in addition to the standard sequential work-up (SW) of bone metastases (technetium-99m bone scintigraphy [BS] completed with targeted x-rays [TXR] in patients with equivocal BS findings and with MRI obtained on request [MRIor] in patients with inconclusive BS/TXR findings). Panel review of initial and 6-month follow-up MRI findings, BS/TXR, and all available baseline and follow-up clinical and biologic data were used as the best valuable comparator to define metastatic status. Diagnostic effectiveness of MRIas alone was compared with each step of the SW. Impact of MRIas screening on patient management and costs was evaluated. RESULTS On the basis of the best valuable comparator, 41 patients (62%) had bone metastases. Sensitivities were 46% for BS alone, 63% for BS/TXR, 83% for BS/TXR/MRIor, and 100% for MRIas; the corresponding specificities were 32%, 64%, 100%, and 88%, respectively. MRIas was significantly more sensitive than any other approach (P < .05, McNemar). MRIas identified metastases in seven (30%) of 23 patients considered negative and eight (47%) of 17 patients considered equivocal by other strategies, which altered the initially planned therapy. Economic impact was variable among countries, depending on reimbursement rates. CONCLUSION MRIas is more sensitive than the current SW of radiographically identified bone metastases in high-risk PCa patients, which impacts the clinical management of a significant proportion of patients.

Does genotyping of risk-associated single nucleotide polymorphisms improve patient selection for prostate biopsy when combined with a prostate cancer risk calculator?

Genome‐wide association studies have identified single nucleotide polymorphisms (SNPs) associated with higher risk of prostate cancer (PCa). This study aimed to evaluate whether published SNPs improve the performance of a clinical risk‐calculator in predicting prostate biopsy result.

Technique de dérivation urinaire non continente transcutanée comme traitement d'un prolapsus de vésicostomie

Vesicostomy prolapse is a frequent complication of an unusual surgical technique in adult patients. We have described a surgical technique to repair a vesicostomy prolapse using subcutaneous tubulisation of thick cutaneous flap taken off the abdominal wall. This technique could help surgeons to cure prolapse of vesicostomy in case of impossible intraperitoneal approach.

Gangrène de Fournier sur escarre ischiatique: utilisation du pansement occlusif aspiratif et stratégie thérapeutique.

Vacuum-assisted closure (V.A.C.) was used in two paraplegic patients with Fourniers gangrene in a context of ischial pressure ulcer This type of dressing facilitated preparation of reconstruction.