Radiofrequency ablation of stage IA non-small cell lung cancer in patients ineligible for surgery: results of a prospective multicenter phase II trial

Background

A prospective multicenter phase II trial to evaluate the survival outcomes of percutaneous radiofrequency ablation (RFA) for patients with stage IA non-small cell lung cancer (NSCLC), ineligible for surgery.

Methods

Patients with a biopsy-proven stage IA NSCLC, staging established by a positron emission tomography-computed tomography (PET-CT), were eligible. The primary objective was to evaluate the local control of RFA at 1-year. Secondary objectives were 1- and 3-year overall survival (OS), 3-year local control, lung function (prior to and 3 months after RFA) and quality of life (prior to and 1 month after RFA).

Results

Of the 42 patients (mean age 71.7 y) that were enrolled at six French cancer centers, 32 were eligible and assessable. Twenty-seven patients did not recur at 1 year corresponding to a local control rate of 84.38% (95% CI, [67.21–95.72]). The local control rate at 3 years was 81.25% (95% CI, [54.35–95.95]). The OS rate was 91.67% (95% CI, [77.53–98.25]) at 1 year and 58.33% (95% CI, [40.76–74.49]) at 3 years. The forced expiratory volume was stable in most patients apart from two, in whom we observed a 10% decrease. There was no significant change in the global health status or in the quality of life following RFA.

Conclusion

RFA is an efficient treatment for medically inoperable stage IA NSCLC patients. RFA is well tolerated, does not adversely affect pulmonary function and the 3-year OS rate is comparable to that of stereotactic body radiotherapy, in similar patients.

Trial registration

ClinicalTrials.gov Identifier NCT01841060 registered in November 2008.

Parametric study of horizontally vibrated grain packings: comparison between Discrete Element Method and experimental results

Numerical and experimental studies have been undertaken to analyze three parameters controlling the compaction of granular media submitted to sinusoidal horizontal vibrations. We have characterized the influence of the dimensionless acceleration Γ, the geometry of the container and the friction coefficients on the grain velocities and on the packing densities. Above a critical acceleration Γ, the velocities increases with Γ. For low values of Γ, the surface layers are compacted, whereas the bottom layers remain at their initial density. For high values of Γ, the bottom layers get compacted, the surface layers are fluidized so that the bulk dynamic and relaxed densities decreased. In the same way, the effect of the dimensions of the container and of the friction coefficients on the packing properties has been studied for given heights of sand, acceleration and frequency. It has been shown that the influence of the two last parameters is similar to that of acceleration. The numerical results given by the Discrete Element Method appear to be in good agreement with experimental results.

Acute elbow trauma in children: role of ultrasonography

BACKGROUND

The diagnosis of occult elbow fracture in children is often challenging due to equivocal or negative repeated radiographic findings.

OBJECTIVE

To evaluate the potential diagnostic role of US in children who have sustained elbow trauma with an elbow joint effusion but no fracture seen on initial radiographs.

MATERIALS AND METHODS

The study included 14 consecutive children (age range 5-15 years) with elbow trauma whose elbow radiographs showed an effusion without fracture who underwent emergency imaging (within the first 72 h) with US and MRI. The aim of US was to demonstrate a lipohaemarthrosis in relation to a cortical fracture. MR imaging was used as the reference to differentiate fracture from bone or muscle contusions.

RESULTS

In seven children US demonstrated a lipohaemarthrosis, and MRI demonstrated a cortical fracture in all these children. Conversely, among the seven children with simple haemarthrosis seen on US, MRI did not identify a cortical fracture in six and demonstrated a cortical fracture in one.

CONCLUSION

Posttrauma elbow joint effusion in children is not always related to a cortical fracture. US appears to be a reliable, accurate, widely available and effective low-cost tool in these cases. The diagnostic clue is the detection of a lipohaemarthrosis in the articular recess.

Acute knee trauma: role of ultrasound

The purpose of this study was to determine the diagnostic accuracy of high spatial resolution ultrasonography (US) in the detection of lipohemarthrosis of the knee and to evaluate this sign as criteria of intra-articular fracture. Forty-eight patients with clinical suspicion of knee fracture were prospectively examined by conventional radiography, sonography examination and computed tomography (CT) within 48 h after trauma in order to depict direct (fracture line) and indirect (lipohemarthrosis) signs of intra-articular fracture. Lipohemarthrosis was defined as a multi-layered collection in the subquadricipital recess. CT was considered as the gold standard for both direct and indirect fracture criteria. CT imaging showed direct signs of intra-articular fracture in 31 patients (65%). Among these patients, 30 (97%) had a lipohemarthrosis. Conventional radiographs showed intra-articular fracture in 26 patients (54%). Among these, 18 (69%) had a lipohemarthrosis. Sonographic examinations could not depict any direct sign of intra-articular fracture but showed a lipohemarthrosis in 29 (93%) of patients with proven fracture via CT. This allowed the depiction of four out of five occult knee fractures. The sensitivity, specificity, positive predictive value, negative predictive value of sonography for the diagnosis of lipohemarthrosis was 97, 100, 100 and 94%, respectively, compared with 55, 100, 100 and 55% with conventional radiographs. Using lipohemarthrosis as criterion of fracture, the sensitivity, specificity, positive predictive value and negative predictive value of sonography for early detection of intra-articular knee fractures was 94, 94, 97 and 89%, respectively, compared with 84, 88, 93 and 75% with conventional radiographs. We concluded that, by showing lipohemarthrosis in the subquadricipital recess, high-resolution sonography is a reliable and accurate technique for the evaluation of intra-articular knee fractures.

Prenatal Diagnosis of Hypochondroplasia: Three-Dimensional Multislice Computed Tomography Findings and Molecular Analysis

We report the first case of sporadic hypochondroplasia diagnosed in utero by computed tomography (CT) three-dimensional (3D) imaging and molecular analysis at 38 weeks' gestation. Prenatal sonographic examinations performed at 32 and 35 weeks' gestation revealed a rhizomelic shortness of the long bones (femur and humerus) with macrocephaly. Based on these findings, a nonlethal form of skeletal dysplasia was suspected and a multislice CT imaging with 3D reconstruction was performed depicting skeletal abnormalities which suggested hypochondroplasia. The prenatal diagnosis was confirmed by DNA mutation analysis of the fibroblast growth receptor 3 gene.

Fetal Extradural Hematoma: Prenatal Diagnosis and Postmortem Examination

We report the 1st confirmed case of an extradural hematoma diagnosed in utero by ultrasonography and magnetic resonance imaging at 31 weeks' gestation. No signs of intracranial hemorrhage were found. During pregnancy, the expecting mother suffered from sustained cough, and a blood sample test revealed acute pertussis. The presence of fetal hydrocephaly, brain parenchymal deviation, and other abnormalities suggested a poor outcome, and based on these findings pregnancy termination was recommended and carried out. Postmortem examination confirmed the diagnosis of an extradural hematoma in the posterior fossa.

Serial chest CT findings in interstitial lung disease associated with polymyositis–dermatomyositis

OBJECTIVE

A retrospective study was carried out in two institutions to determine serial changes in the pattern, distribution, and extent of interstitial lung disease (ILD) associated with polymyositis (PM)-dermatomyositis (DM) using HRCT.

SUBJECTS AND METHODS

Twenty patients with PM-DM and clinical suspicion of ILD who underwent at least two serial HRCT examinations were retrospectively evaluated by two readers. Patients were classified according to the dominant CT pattern which was correlated with clinical evolution and underlying histology when available (n=6).

RESULTS

Patients were classified into four groups according to the dominant pattern: ground-glass attenuation and reticulation (group 1, n=9); honeycombing (group 2, n=4); airspace consolidation (group 3, n=4), and normal or almost normal lung (group 4, n=3). Under medical treatment, serial HRCT showed that the extent of areas of ground-glass opacities (group 1) decreased in five patients, stabilized in two, and increased in two. Pathologic findings demonstrated usual interstitial pneumonia (UIP) in two cases and unspecified interstitial pneumonia in one. In group 2, extent of honeycombing increased in three cases and stabilized in one. In group 3, dramatic resolution of airspace consolidation occurred in three cases. Clinical deterioration with extensive consolidation at CT and diffuse alveolar damage (DAD) at histology occurred in one patient of each of the three previous groups. Lesions stayed invisible or progressed slightly in the fourth group.

CONCLUSION

In ILD associated with PM-DM, clinical deterioration and DAD in the follow-up can be observed whatever the HRCT pattern. However, unfavorable evolution is constant when honeycombing is present at the initial CT.

Occult fractures of the waist of the scaphoid: early diagnosis by high-spatial-resolution sonography

OBJECTIVE

This study evaluated the diagnostic accuracy of high-spatial-resolution sonography in the diagnosis of occult fractures of the waist of the scaphoid.

SUBJECTS AND METHODS

Sonography of the scaphoid bone with a 12-MHz transducer was performed in 54 patients with clinically suspected scaphoid fracture and normal findings on initial radiographs, including specific scaphoid images. Three levels of clinical suspicion were considered: high (20%), moderate (30%), and low (50%). Attention was paid to the continuity of the scaphoid cortex and to the surrounding soft tissues (i.e., hemarthrosis or hematoma). Data from early sonograms were then compared with the results of radiography repeated 10-14 days after the initial trauma. In cases of persistent suspicion despite normal findings on follow-up radiographs, the presence of fracture was evaluated on CT (four patients), MR imaging (one patient), or bone scanning (one patient).

RESULTS

Follow-up examinations proved fracture of the scaphoid waist in five patients. In all patients, diagnosis of fracture was suspected on initial sonograms showing cortical disruption associated with soft-tissue abnormalities. There was one false-positive finding and no false-negative results. Using cortical disruption as a diagnostic criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography for the depiction of scaphoid fracture to be 100%, 98%, and 98%, respectively. Using soft-tissue abnormalities alone as a criterion, we found the sensitivity, specificity, and accuracy of high-resolution sonography to be 100%, 65%, and 68%, respectively. The overall prevalence of occult fracture was 9%, ranging from 3.7% for low suspicion to 27% for high suspicion of fracture.

CONCLUSION

High-resolution sonography is a reliable and accurate method of evaluating occult fractures of the scaphoid waist. Cortical disruption is the diagnostic key. Soft-tissue abnormalities alone lack specificity.