Lucie Salomon du Mont

May Thurner syndrome revealed by left calf venous claudication during running, a case report

BackgroundMay Thurner syndrome is relatively unknown to physicians, its management is well standardized and the outcomes of treatment are satisfactory in the short to medium term.Case presentationWe report the case of a patient who suffered from venous claudication during running which impaired their quality of life, decreased their athletic performance and resulted in a career change. May Thurner syndrome diagnosis was made after extensive hemodynamic analysis of a lower limb venous duplex ultrasound scan. This diagnosis was later confirmed by imaging. Subsequent endovascular care provided rapid and sustained clinical improvement.ConclusionThe main difficulties with the May Thurner syndrome are to think about it and know how to look for it; indeed the misdiagnosis time can be long. When diagnosis is made, treatment could be easy and effective.

Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery: A Phase II/III Randomized Trial

Background: We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients. Methods: Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups. Results: In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group. Conclusions: Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.

Long-term compliance with a validated intravenous insulin therapy protocol in cardiac surgery patients: a quality improvement project

Quality problem Safe and efficient blood glucose (BG) level control after cardiac surgery relies on an intensive care unit (ICU) team-based approach, including implementation of a dynamic insulin therapy protocol (ITP). Long-term compliance with such a complex protocol is poorly addressed in the literature. The aim of this study was to assess the long-term compliance of nurses with the ITP, 7 years after its implementation in the ICU. Initial assessment A professional practice evaluation, integrated in a process of quality improvement program, was retrospectively conducted on 224 consecutive cardiac surgery patients over a 6-month period (PHASE 1). The timing of BG measurements and the insulin infusion rate adjustments (primary endpoints) were correctly performed according to protocol requirements in 35 and 53% of the cases, respectively. Choice of solution and implementation After systemic analysis of the causes of protocol deviations, four corrective measures aiming at improving both physician and nurse adherence to the protocol were implemented in the ICU. Evaluation Evaluation of 104 patients in PHASE 2 showed a significant improvement in both the timing of BG measurements (83 %, P < 0.001 vs. PHASE 1), and insulin infusion rate adjustments (76%, P < 0.001). Lessons learned Seven years after the implementation of a dynamic insulin infusion protocol, major protocol deviations were observed. Identification of several causes after a professional practice evaluation and the implementation of simple corrective measures restored a high level of nurse compliance.

How to identify patients at risk of abdominal compartment syndrome after surgical repair of ruptured abdominal aortic aneurysms in the operating room: A pilot study

Objectives Abdominal compartment syndrome (ACS) is poorly identified in surgery for ruptured abdominal aortic aneurysm and an early management is crucial. The aim of this study was to validate how many risk factors were needed to predict ACS. Secondary objectives were to assess its prevalence and the 30-day mortality. Methods All patients operated for ruptured abdominal aortic aneurysm during 5 years were included. An independent committee performed a retrospective diagnosis of ACS. Eight criteria were selected from the literature, and corresponded to pre- and intraoperative period: anemia (hemoglobin lower than 10 g/dL), prolonged shock (systolic blood pressure <90 mmHg more than 18 min), preoperative cardiac arrest, obesity (body mass index > 30), massive fluid resuscitation (≥3500 mL per hour for at least 1 h) and transfusions (>10 units packed blood red cell since the beginning of the treatment), severe hypothermia (≤33℃), acidosis (pH < 7.2). Sensitivity and specificity were assessed for each number of criteria. Results Eight patients were ACS+ and 28 ACS-, with three criteria for ACS+ and 1.5 for ACS- (p = 0.002). Three criteria among the eight selected criteria have the best cutoff for sensitivity and specificity (75% and 82%) with a positive predictive value of 54% and a negative predictive value of 92%. The prevalence of ACS was 17%. The 30-day mortality in ACS+ tended to be higher than in ACS- (p = 0.108). Conclusion The present results suggest that patients with an ACS seemed to have higher mortality and the threshold of three factors among eight specific factors is enough to predict this.

Retrograde Approach for Femoro-popliteal or Complex Tibial Occlusions

Death rates at six and 12 months were 7% and 12%, respectively. The rates of limb salvage at six and 12 months were 95% and 93%, respectively. The rates of patency of the target artery at six and 12 months were 93% and 89%, respectively. The rates of healing at six and 12 months were 58% and 76%, respectively. Conclusion: The results of this large series confirm the effectiveness of the endovascular technique in the treatment of the lesions of the leg arteries for critical ischemia. In addition to the description of the population, this study allows the analysis of the lesions observed and the lesions treated as well as the evaluation of the technical sides, the material employed and their specific results.