T. Smayra

Long-term results of endovascular stent placement in the superior caval venous system.

AbstractPurpose: To present the long-term results in superior caval stenting for symptomatic obstruction. Methods: Forty-nine stents were placed in 30 patients: 16 (53%) with malignant lesions, five (17%) with benign lesions and nine (30%) hemodialysis patients. Self-expandable stents were deployed on a first-line basis. Patients were followed clinically as well as by various imaging techniques and survival analysis was performed. Results: Stent deployment was possible in all cases. Reocclusion was seen in 13 patients, of whom eight belonged to the hemodialysis group. Primary and secondary patency rates for malignant, benign and hemodialysis patients were respectively 74%, 50% and 22%, and 74%, 75% and 56% at 1 year. We had 7% complications and one death from iatrogenic superior vena cava injury. Conclusion: Primary stenting of superior caval obstruction is a first-choice treatment method achieving good mid-term patency. Patients with hemodialysis shunts must be closely monitored for early reintervention.

Pseudoaneurysm and aortobronchial fistula after surgical bypass for aortic coarctation: management with endovascular stent-graft.

Purpose: To report the endovascular repair of an aortobronchial fistula at the distal anastomosis of a complex thoracic graft. Case Report: A 61-year-old man operated 18 years prior for aortic coarctation presented with hemoptysis. An aortobronchial fistula was suspected, but spiral computed tomography and angiography showed only a small pseudoaneurysm at the distal anastomosis without revealing the fistulous tract. A Talent stent-graft was successfully deployed through a femoral access, but the large delivery system injured the external iliac artery, producing a retroperitoneal hemorrhage. Prompt balloon occlusion of the aorta and subsequent bypass graft repair of the arterial injury prevented serious sequelae. The patient recovered without further complications. Follow-up imaging to 2 years has documented exclusion of the pseudoaneurysm with no hemoptysis or signs of new false aneurysm formation. Conclusions: Endovascular exclusion of anastomotic pseudoaneurysms even in complicated cases can be an efficient treatment option, but the procedure must be carefully planned and executed in order to achieve good results.

Intrathyroid parathyroid adenoma in primary hyperparathyroidism: can it be predicted preoperatively?

IntroductionThe role of cervical ultrasonography (US)-guided surgery for intrathyroid parathyroid adenoma in primary hyperparathyroidism is rarely reported. The aim of this study was to elucidate the role of cervical US in identifying this entity.MethodsFrom 1996 to 2003, cervical explorations were performed in 178 patients (mean age 57 years) with primary hyperparathyroidism. High-resolution cervical US was performed in all of the patients. Patients’ characteristics were reviewed to identify predictive factors for intrathyroid adenoma.ResultsCervical US identified abnormal parathyroid glands in 163 of 178 patients, with a positive predictive value (PPV) of 100%. Six patients (3.4%) were found to have intrathyroid parathyroid adenomas (two in the superior parathyroid and four in the inferior parathyroid). Cervical US predicted this anomaly in four of six patients (67%) in whom the thyroid gland was not nodular and allowed total enucleation of the adenoma to be performed in three and subtotal thyroid loboisthmectomy in three; these operations were performed uneventfully and rapidly. The PPV in this anomaly was 80%. Thirteen patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at the time of the last clinic visit, with follow-up varying from 12 to 96 months. On multivariable analysis, no factor predicted intrathyroid localization of parathyroid adenoma.ConclusionsThe PPV of high-resolution cervical US for identifying an abnormal parathyroid gland was 100% in this series. It was 80% for predicting intrathyroid localization of the adenoma. This method allows us to shorten the operating time by guiding the exploration immediately toward the thyroid gland.

Ultrasonography : Highly Accuracy Technique for Preoperative Localization of Parathyroid Adenoma

Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism.

In Vitro Evaluation of a New Rotational Thrombectomy Device: The Straub Rotarex Catheter

AbstractPurpose: To evaluate the efficacy of a new rotational thrombectomy device, and the procedure-related risk of particle embolization. Methods: The experiments were performed in transparent silicone tubes. The conditions of flow were as close as possible to physiological parameters. Distal embolization was detected by a mesh of nylon filters. Results: The Straub Rotarex catheter was able to remove all clots. The mean number of migrating particles larger than 1000 μm was 0.17 (±0.38), the mean number of 400–1000 μm migrating particles was 1.08 (±1.04). The mean intervention time was 67 (±37) sec. The mean volume of collected liquid was 96.6 (±24.7) ml. Conclusion: The in vitro results suggest that the Straub Rotarex catheter is able to remove large volumes of thrombus with a limited risk of embolization. The main limitation of our model is the absence of adhesion of the clot to the tube.

Aspect échographique des fractures des extrémités

Limb fractures: ultrasound imaging features. US, a non-irradiating imaging modality, is complementary to radiographs in the evaluation of limb fractures. US may in some cases demonstrate or suggest the presence of a fracture without corresponding abnormality on radiographs, or confirm or exclude a possible fracture detected on radiographs. Knowledge of the US features of fractures is necessary. In this article, the different direct and indirect US findings of fractures will be reviewed, with radiographic correlation. Direct findings include cortical discontinuity or irregularity. Indirect findings include subperiosteal or juxtaphyseal hematoma suggesting cortical or physeal fractures respectively.

Customized Polymethylmethacrylate Cranioplasty Implants Using 3-Dimensional Printed Polylactic Acid Molds: Technical Note with 2 Illustrative Cases

OBJECTIVES Prefabricated customized cranioplasty implants are anatomically more accurate than manually shaped acrylic implants but remain costly. The authors describe a new cost-effective technique of producing customized polymethylmethacrylate (PMMA) cranioplasty implants with the use of prefabricated 3-dimensional (3D) printed molds. METHODS The first patient had a left frontal cranial defect after a craniotomy for a glial tumor. A 3D image of his skull was obtained from axial 0.6-mm computed tomography (CT) scan images. The image of the implant was generated by a digital subtraction mirror-imaging process using the normal side of his cranium as a model. The second patient had a bifrontal defect after the resection of an infected customized polyetheretherketone implant. A 3D image of the infected implant was directly obtained from an axial 0.6-mm CT scan before discarding it. The images were then used to produce for each patient a mold of the external surface of the cranium using a low-cost polylactic acid 3D printer. Intraoperatively, each mold was put in a sterile bag and then used to cast a customized PMMA implant subsequently trimmed before fixation. RESULTS Both patients had excellent cosmetic results and underwent postoperative CT scans that showed excellent restoration of the symmetrical contours of the cranium. No neurologic or infectious complications occurred over a 6-month follow-up for either patient. CONCLUSIONS Making customized PMMA cranioplasty implants via 3D printed polylactic acid molds is a cost-effective technique for delayed reconstruction of various cranial defects.

Faux anévrysme de l’aorte abdominale naissant dans un magma ganglionnaire : diagnostic par écho Doppler et traitement par embolisation

OBJECTIVE: To report a case of pseudoaneurysm of the abdominal aorta due to retroperitoneal enlarged lymph nodes. MATERIALS AND METHODS: A 40 years old patient, with known sarcoma and metastatic retroperitoneal lymph nodes was referred for abdominal ultrasound because severe abdominal pain after defecation. RESULTS: The Doppler examination revealed magma of retroperitoneal lymph nodes surrounding the abdominal aorta inside of which a saccular collection of circulating blood, communicating with the aorta, was detected. The spectrum registered in the channel revealed a bidirectional flow compatible with a pseudoaneurysm. MR angiography confirmed the diagnosis. Successful occlusion was done by coil embolization. CONCLUSION: Pseudoaneurysms of the abdominal aorta are very rare. We report the first case of pseudoaneurysm arising in retroperitoneal lymph nodes. Diagnosis by Doppler ultrasound allowed a rapid treatment by embolization.

Localisation atypique d'un adénome parathyroïdien : la gaine carotidienne

We report the imaging features of an occult parathyroid adenoma with unusual location in the carotid sheath. Our patient presented with primary hyperparathyroidism. Following negative neck ultrasound and scintigraphy, exploratory neck dissection with partial thyroidectomy was performed twice over a 2 day period without biological response. Cervical and mediastinal CT and MRI were performed with no result. Digital angiography showed a tumoral blush supplied by the left inferior thyroid artery and located in close contact with the carotid artery. Venous sampling of the neck confirmed the left location of the adenoma and a third surgical intervention found the adenoma embedded in the left carotid sheath. This is an unusual case of parathyroid adenoma that necessitated the use of several imaging techniques.

Filtre carotidien inversé pour la protection des embolies distales lors d’une recanalisation iliaque

Resume Les auteurs decrivent l’utilisation originale d’un filtre carotidien pour prevenir l’embolie distale lors de la recanalisation d’une occlusion de stent iliaque vieille de 2 mois. Le filtre inverse est introduit ipsilateralement au stent occlus. L’occlusion est recanalisee par abord controlateral avec mise d’un nouveau stent. Plusieurs emboles sont recuperes dans le filtre retire. Les auteurs relevent que la recanalisation d’un stent est plus emboligene que celle d’une artere native. Cette methode permet de placer le filtre entre la lesion emboligene et le territoire a proteger, sans avoir a traverser la lesion, surtout que les fibrinolytiques sont peu efficaces a 2 mois.