Stress shielding following radial head arthroplasty: the impact of preoperative bone quality

INTRODUCTION

We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of Stress shielding (SS) after a MoPyC radial head arthroplasty (RHA).

MATERIAL & METHOD

We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ±14.90 (range, 25.00; 91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ±2.8 (range, 0.5-11).

RESULTS

Stress shielding was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ±0.09, 1.05 ±0.18 and 0.79±0.11, respectively. The presence of SS was significantly associated with MD:CW (aOR=13.66; p=0.001), and expansion of the stem (aOR=3.78; p=0.001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; p<0.001).

CONCLUSIONS

Our study found that MD:CW was an independent risk factor of SS after Mopyc RHA. Patients with longer and larger diameter (auto-expansion) Mopyc stems were also at significantly increased risk of SS. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study.

[REFORCE registry]

Severe coronary artery calcification, too often underestimated, increases the complexity of percutaneous coronary interventions. Atherectomy is one of preferred approach for the preparation of calcified lesions before stent placement. Orbital atherectomy is a new method that has proven to be safe and effective in the preparation of calcium plaques (ORBIT I and ORBIT II studies). The recent introduction in France allows to perform a prospective registry named REFORCE. Its main objective is to include 300 patients in order to evaluate security and safety of the device in France during routine use.

Direct wire pacing during measurement of fractional flow reserve: A randomized proof-of-concept noninferiority crossover trial

Background

Adenosine administration for fractional flow reserve (FFR) measurement may induce heart pauses.

Aims

To assess the accuracy and tolerability of direct wire pacing (DWP) during measurement of FFR.

Methods

Adults with at least one intermediate coronary artery stenosis (40%-80%) were consecutively enrolled between June 2021 and February 2022 in this randomized, noninferiority, crossover trial (NCT04970082) carried out in France. DWP was applied (DWP) or not (standard method) through the pressure guidewire used for FFR measurement during adenosine-induced maximal hyperaemia. Subjects were randomly assigned to the allocation sequence (DWP first or standard first). A 2-minute washout period was observed between the two FFR measurements performed for each stenosis. The primary endpoint was the reproducibility of FFR measurements between methods.

Results

A total of 150 focal lesions, presented by 94 subjects, were randomized (ratio: 1:1). The FFR values obtained with each method were nearly identical (R = 0.98, p = 0.005). The mean FFR difference of 0.00054 (95% confidence interval: 0.004 to 0.003) showed the noninferiority of FFR measurement with DWP vs. that with the standard method. Higher levels of chest discomfort were reported with DWP than with the standard method (0.61 ± 0.84 vs. 1.05 ± 0.89, p < 0.001), and a correlation was observed between the electrical sensations reported with DWP and chest discomfort (p < 0.001). Pauses (n = 20/148 lesions) were observed with the standard method, but did not correlate with chest discomfort (p = 0.21). No pauses were observed with DWP.

Conclusions

DWP during FFR measurement resulted in accurate and reproducible FFR values, and eliminated the pauses induced by adenosine.

Intra-abdominal abscess from dropped gallstone: A case report

Dropped gallstones are a common complication during a laparoscopic cholecystectomy. The formation of an abdominal abscess related to the dropped gallstones is rare because the majority of these calculi do not cause complications. Ultrasound is a usually used first-line imaging modality to detect gallstones in the abscess. CT scan may be used to confirm the diagnosis of abscess and for topographic analysis. We report the case of a lady presented to the emergency department 2 months after laparoscopic cholecystectomy; for acute cholecystitis; with acute abdomen and fever. Laboratory values revealed an elevated white blood cell count (WBC) and C-reactive protein concentration (CRP). The diagnosis of intra-abdominal abscess was evoked by ultrasound and contrast-enhanced CT, and confirmed by laparoscopy. The purpose of this paper is to illustrate the importance of searching and recognizing dropped gallstone within collection, particularly in the context of previous laparoscopic cholecystectomy.

Cross-cultural adaptation and validation of the Moroccan version of the Glaucoma Quality of Life-15 (GQL-15) questionnaire in patients with glaucoma

BACKGROUND

Glaucoma is the second leading cause of blindness in the world. In addition, visual impairment and psychological strain have been shown to have a significant impact on quality of life (QoL) in glaucoma patients. Maintaining the quality of life of glaucoma patients has become an important component of treatment. The goal of this study is to develop a Moroccan Arabic dialect version of the Glaucoma Quality of Life-15 questionnaire and to examine its psychometric properties.

METHODS

The Glaucoma Quality of Life-15 questionnaire was translated and cross-culturally adapted into Moroccan Arabic dialect and administered to glaucoma patients recruited from the ophthalmology department of the Omar Drissi Hospital, Hassan II University Hospital, Fez. Sociodemographic and other clinical data were collected. Psychometric properties were performed, including internal consistency, which was tested using Cronbach's alpha (α), test-retest reliability using intraclass correlation coefficients (ICC). Construct validity was assessed by examining the convergent and divergent validity of items.

RESULTS

The questionnaire was administered to 148 patients with a mean age of 60.91 ± 15.10 years. Over half of the patients were female (58.1%), patients were married (77.7%), illiterate (62.2%) and unemployed (82.3%). The majority of patients had primary open angle glaucoma (68.9%). The mean time to complete the GQL-15 was 3.26±0.51min. The mean summary score for the GQL-15 was 39.50±16.76. Cronbach's alpha for the entire scale was 0.95 (central and near vision 0.58; peripheral vision 0.94; glare and dark adaptation 0.87).

CONCLUSION

The Moroccan Arabic dialect version of the GQL-15 demonstrates adequate reliability and validity. Therefore, this version could be used as a reliable and valid tool for quality-of-life assessment in Moroccan glaucoma patients.

A direct wire pacing device for transcatheter heart valve and coronary interventions: a first-in-human, multicentre study of the Electroducer Sleeve

BACKGROUND

Transcatheter aortic valve implantation (TAVI) and complex percutaneous coronary interventions (PCI) may require cardiac pacing during device delivery, generally requiring the insertion of a temporary pacing lead via an additional venous access site. The purpose-built Electroducer Sleeve device provides direct wire pacing without the need for a temporary venous pacemaker.

AIMS

This study assessed the safety of temporary cardiac pacing using the novel sleeve device during PCI.

METHODS

This was a multicentre, non-randomised, prospective, first-in-human, single-arm, pilot study. The primary endpoint was analysis of a safety outcome, defined as the occurrence of haematomas or bleeding complications at the device vascular access site. Secondary endpoints included analyses of effectiveness and qualitative outcomes.

RESULTS

Sixty patients (mean age: 77.9±9.6 years) from 4 centres in France were included: 39 (65%) underwent TAVI, and 21 (35%) underwent PCI. Procedures were performed using the sleeve with access through the radial (32 patients; 53.3%) or femoral arteries (26; 43.3%), or the femoral vein (2; 3.3%). Primary endpoint analysis revealed that 2 patients (3.3%) developed EArly Discharge After Transradial Stenting of CoronarY Arteries Study (EASY) grade I/Bleeding Academic Research Consortium (BARC) type I haematomas at the device access site. As a measure of effectiveness, a haemodynamic effect was observed after each spike delivery in 54 patients (90%). Analyses of other secondary endpoints showed that 2 patients (6.3%) presented asymptomatic radial artery occlusion. No allergies were reported.

CONCLUSIONS

This first-in-human trial using the Electroducer Sleeve indicated that this novel, purpose-built, temporary pacing device was safe and effective. Larger prospective studies are required to confirm these findings.

Comparison of outcomes in patients with or without ARC-HBR criteria undergoing PCI with polymer-free biolimus coated stents: The BioFreedom France study

BACKGROUND

The polymer-free biolimus coated stent (BioFreedom) was shown to be superior to bare metal stents in the LEADERS FREE randomized trial in high bleeding risk (HBR) patients treated with 1-month dual antiplatelet therapy (DAPT). However, there is limited outcome data with this device in an all-comers' population.

METHODS

We conducted a prospective single-arm study of patients undergoing percutaneous coronary intervention with the polymer-free biolimus coated stent in 25 centers in France with wide inclusion criteria including multivessel disease, complex lesions, and acute coronary syndromes. The primary endpoint was the incidence of target lesion failure (TLF), a composite of cardiac death or target-vessel myocardial infarction (MI) or clinically indicated target lesion revascularization (ci-TLR) at 1-year. The patient population was classified according to the presence (or not) of HBR criteria according to the recent ARC-HBR definition.

RESULTS

Between April 2019 and April 2020, 1497 patients were enrolled. TLF occurred in 101 (6.9%) patients, including cardiac death in 35 (2.4%), target vessel MI in 20 (1.4%) and ci-TLR in 65 (4.5%) of them. There were 491 HBR patients (32.8%) and 1006 non-HBR patients. The median duration of DAPT was 74 days in the HBR group versus 348 days in the non-HBR group (p < 0.0001). TLF occurred in 44 (9.2%) of the HBR group and in 57 (5.8%) of the non-HBR group (relative risk 1.62 [95% confidence interval: 1.10-2.41], p = 0015). Compared to the non-HBR group, HBR patients had higher rates of cardiac death (4.4% vs. 1.4%, p = 0.0005) and target vessel MI (2.9% vs. 0.6%, p = 0.0003), but similar rates of ci-TLR. BARC 3-5 bleeding occurred in 6.2% of the HBR group versus 1.4% of the non-HBR group (p < 0.0001).

CONCLUSION

In this multicenter all-comers study, HBR patients treated with a polymer-free biolimus coated stent had, compared to non-HBR patients, an increased risk of cardiac death and MI, and despite a shorter duration of DAPT, continued to have higher rates of BARC 3-5 bleeding.

Malignant transformation of a mature retroperitoneal teratoma into adenocarcinoma

Retroperitoneal mature teratoma is a rare congenital tumor, far behind ovarian and testicular localizations. Malignant transformation of teratomas is extremely uncommon. We report a case of a 23-year-old female, who presented with chronic pelvic heaviness, abdominopelvic ultrasound revealed a cystic mass in the right iliac fossa, initially considered as a functional ovarian cyst. Given the persistence of the patient's symptoms a pelvic MRI was requested. It showed a right retro-colic cystic unilocular with parietal nodule. The two ovaries showed normal appearance. A retroperitoneal teratoma was suggested given the retroperitoneal topography of the mass, and the presence of a tissular parietal nodule. She underwent surgery and the diagnosis was confirmed after histological study

Extensive prostatic abscess drained by CT-guided percutaneous approach: Case report

Prostatic abscess is a rare entity that occurs most frequently after the age of 50. The main risk factors are immunosuppressive conditions such as diabetes, HIV infection and chronic renal failure. It is clinically manifested by signs of bladder irritation. The management of the disease involves antibiotic therapy and drainage of the abscess, which can be performed by various invasive methods. We report the case of a 60-year-old patient with a large prostatic abscess drained by CT-guided percutaneous approach.

Safety of conservative management for non-stenotic culprit lesions in STEMI patients treated with a two-step reperfusion strategy: a SUPER-MIMI sub-study

BACKGROUND

In the observational SUPER-MIMI study, a minimalist immediate mechanical intervention (MIMI) technique-which involves restoring blood flow in the acute phase and postponing stenting-was shown to be safe and effective among patients with a high thrombotic burden after ST-segment elevation myocardial infarction (STEMI). We aim to assess whether a non-stenting strategy after a SUPER-MIMI strategy was safe at 4-year follow-up in patients enrolled in the SUPER-MIMI study who were not stented.

METHODS

This prospective cohort study assessed the long-term outcomes of a subgroup of patients included in the SUPER-MIMI study.

RESULTS

Among the 155 patients enrolled in the SUPER-MIMI study, 57 patients (36.8%) benefited from a conservative management (without stenting or balloon angioplasty) and were included in the current substudy. The mean duration of follow-up was 4.1±1.0 years. Four patients (7.0%) presented definite culprit lesion re-thrombosis, all of which occurred in the right coronary artery. The re-thrombosis rate appeared to be higher among patients with larger vessels: 2.9%, 8.3%, and 28.6% in arteries with diameters of 3-<4, 4-<5, and ≥5 mm, respectively. The overall rate of target lesion revascularization was 10.5%. There was one cardiac death and three rehospitalizations for heart failure. Overall, 82.5% of patients remained event free at a mean of 4.1±1.0 years.

CONCLUSIONS

Conservative management of non-stenotic culprit lesions after a SUPER-MIMI strategy was associated with a high rate of re-thrombosis, particularly in patients with large coronary arteries.

Direct Wire Pacing for Challenging Left Main Stenting: An Old Technique Revived

During stent positioning after predilating with a non-compliant balloon, we observed major motion of our device in the left main coronary artery. Under those conditions, accurate stent placement was uncertain. To remedy this situation, we decided to perform a rapid direct wire pacing with a good final angiographic result.

[Impact of the SARS-CoV-2 pandemic on diabetic macular edema and prognostic factors]

But

Décrire le retentissement sur l’acuité visuelle et l’épaisseur centromaculaire après arrêt des injections intravitréennes d’anti-VEGF chez les patients diabétiques marocains au cours de la pandémie du Coronavirus. Et étudier les facteurs pouvant être associés à l’aggravation.

Matériel et méthodes

Cette étude transversale monocentrique a inclus les patients programmés pour injections intravitréennes de Bevacizumab au cours de la période du confinement (20 mars 2020–20 mai 2020) et qui n’en ont pas bénéficié. Ont été recueillis : l’âge, le sexe, l’ancienneté du diabète, le nombre d’injections reçues avant le confinement, l’acuité visuelle en pré-confinement et post-confinement ainsi que l’épaisseur centromaculaire pré-confinement et post-confinement.

Résultats

Cent cinquante quatre yeux de 104 patients ont été analysés. 57,8 % étaient des hommes avec une moyenne d’âge de 59,4 ± 9,04 ans. La durée moyenne d’arrêt des injections intravitréennes est de 57,3 ± 6,7 jours. Le nombre moyen d’injections intravitréennes de Bevacizumab reçues avant le confinement a été estimé à 2,29 ± 2,1. L’aggravation de l’acuité visuelle a été notée chez 44,8 % de nos patients. Les facteurs associés à l’aggravation fonctionnelle sont le faible nombre d’injections intravitréennes de Bevacizumab reçues avant le confinement (p = 0,001) ainsi que le déséquilibre diabétique (p = 0,04). L’aggravation structurelle a été constatée chez 26,6 % des patients et elle était associée au faible nombre d’injections réalisées avant le confinement (p = 0,038).

Conclusion

Le report des injections intravitréennes au cours du confinement a eu des effets négatifs sur l’acuité visuelle et l’épaisseur centromaculaire des yeux avec OMD. Un report prolongé des injections intravitréennes d’anti-VEGF chez les patients diabétiques doit être évité.

Scrotal leiomyoma: An uncommon cause of chronic scrotal swelling

Leiomyoma is a benign tumor that arises from smooth muscle. It may be encountered at any part of the body especially the uterus. However, scrotal localization is very uncommon, hence it often requires radiologic and pathology correlation to establish an accurate diagnosis and make optimal decisions for subsequent treatment. We present a case of an 82-years-old male, presenting with a left scrotal mass. Ultrasound and MRI demonstrated a left paratesticular mass. Surgery was then indicated and pathology results were consistent with a scrotal leiomyoma.

Tuberculous common bile duct stricture mimicking a cholangiocarcinoma: A case report

Biliary involvement during abdominal tuberculosis is extremely uncommon and represents a challenging diagnosis that can easily be mistaken for a malignant etiology. We report the case of a 40 years old male who presented with anorexia, chronic abdominal pain, and progressive obstructive jaundice. Abdominal computed tomography demonstrated distal narrowing with wall thickening of the main biliary duct, along with enlarged lymph nodes and signs of portal hypertension. Abdominal magnetic resonance imaging showed a long distal biliary stricture, suggestive of malignancy, with dilated intrahepatic radicles. The diagnosis of cholangiocarcinoma was initially suggested. However, given his young age and other imaging findings, the patient underwent laparoscopic biopsy which revealed epithelioid cell granuloma with caseating necrosis consistent with tuberculous origin.

Scleral contact lenses: Visual outcomes and tolerance. A prospective study about 98 eyes

PURPOSE

To assess the improvement in visual acuity (VA), tolerance and quality of life of patients after scleral contact lens (SCL) fitting.

MATERIAL AND METHODS

We carried out a prospective observational study conducted from April 2016 to August 2017. Patients fitted with SCL were included. For the purpose of this study, we analyzed VA and quality of life score (NEI-VFQ25) after 6 months of use.

RESULTS

We identified 98 eyes of 56 patients; the major indication for SCL fitting was keratoconus in 64.3%; the other indications were post-penetrating keratoplasty, other irregular astigmatism, severe ametropia and ocular surface disease. The mean follow-up was 10.71 months. The mean daily wearing time was 9.89±1.63 hours. Best corrected Visual acuity "BCVA" (baseline 1.11±0.37 in the right eye and 1.13±0.42 LogMar in the left eye) improved to 0.19±0.20 and 0.23±0.38 LogMar respectively in the right and left eyes after SCL wear (P=0.000). The scores on the various subscales of the NEI-VFQ 25 questionnaire were significantly higher 6 months after SCL fitting, with a mean score of 87.28±9.87 with SCL versus 39.94±11.33 without these lenses (P=0.000). In our group, no complications related to the SCL wear occurred, except for the occurrence of "loose conjunctival tissue" at the inferior limbus in one patient.

DISCUSSION

Our results complement those of several large series published on this subject. The best visual acuities were reported after correction of irregular astigmatism, in particular keratoconus. Therefore, SCL fitting has become an alternative or a precursor to penetrating keratoplasty in patients with advanced keratoconus. In the case of ocular surface disease, in addition to the improvement in VA, the comfort and recovery of the homeostasis of the ocular surface is greater, with fewer wearing complications. Hence, their inclusion in the therapeutic arsenal for severe ocular surface disease alongside the conventional treatment options.

CONCLUSION

SCL have proven their efficacy and safety in the optical correction of irregular corneas and in the management of ocular surface problems. Additional studies are needed to compare the many lenses currently available and assess optimal fitting strategies for each type of scleral lens for easier fitting procedures and better wearing comfort.

Patent Hemostasis Impact in Clinical Routine: Large Monocentric Echo-Doppler Study of Radial Artery Patency After Coronary Catheterization

BACKGROUND

Radial access is currently the first line of access in interventional cardiology. Nevertheless, this technique carries a 1%-10% risk of radial artery occlusion (RAO) based on series.

METHODS

We conducted a large-scale echo-Doppler evaluation of radial patency including prospectively all patients who underwent coronary angiography and/or angioplasty with radial catheterization at our center in 2018.

RESULTS

A total of 1106 patients were enrolled in the cohort. Average patient age was 70 years, 24.5% were females and 75.5% were males, and 28.3% were diabetics. Five Fr and 6 Fr devices were used in 527 procedures and 565 procedures, respectively. Our study highlighted a very low RAO rate (0.99%). These results are mainly due to the high attention given to patent hemostasis, which was achieved in 1091 patients (98.6%). According to the literature, female gender is a multivariate predictive factor of RAO (P<.01). Furthermore, we confirm the protective nature of heparin (P=.04) with an average heparin dose of 69.73 IU/kg.

CONCLUSIONS

Our study focused on a large population with 1106 patients who underwent radial catheterization shows that a very low rate of RAO (0.99%) can be achieved. These results are correlated with a high attention to patent hemostasis and a close collaboration between the medical and paramedical staff.

Le syndrome de Mayer-Rokitansky-Küster-Hauser comme cause d'aménorrhée primaire: à propos d'un cas

Le syndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) est une cause rare d´aménorrhée primaire. Il est défini par une aplasie congénitale de l´utérus et des deux tiers supérieurs du vagin chez des femmes présentant un développement normal des caractères sexuels secondaires. Le diagnostic est basé essentiellement sur imagerie par résonance magnétique (l´IRM). Nous rapportons le cas d'une fille de 17 ans qui a consulté pour une aménorrhée primaire, avec des caractères sexuels secondaires présents et bien développés. Le bilan biologique a révélé une fonction ovarienne normale ainsi que l´axe gonadotrope. L´échographie pelvienne et l´imagerie par résonance magnétique ont mis en évidence une agénésie complète de l´utérus, des deux tiers supérieurs du vagin et du rein gauche permettant de confirmer le diagnostic du syndrome de Mayer-Rokitansky-Küster-Hauser (MRKH) type II. L´intérêt de ce cas clinique est d'évoquer le diagnostic de MRKH, Devant toute aménorrhée primaire chez une jeune femme présentant des caractères sexuels bien développés, et aussi de chercher les signes spécifiques sur l'imagerie notamment l'IRM.

[Hemifacial spasm. Etiology and management]

INTRODUCTION

Hemifacial spasm (HFS) is an involuntary contracture of the facial muscles innervated by the ipsilateral facial nerve. We studied the etiology of these HFS.

MATERIALS AND METHODS

This retrospective study included 233 patients with HFS who came to the ophthalmologist for quarterly botulinum neurotoxin A injection. Of these, we analyzed the 198 patients for whom MRI scans were performed. We recorded patient clinical data and clarified the etiology of their HFS.

RESULTS

The 198 patients (62.6% women) had a mean age of 55.7±14years. An etiology was found in 52.5% of cases. In 34.5% of HFS, MRI revealed vascular compression where the facial nerve emerged from the brainstem. We specify the arteries involved. Brain tumors accounted for 1.5% of cases. MRI was normal in 64.5% of cases. In these secondary cases of HFS, we found 8.5% peripheral facial palsy, 4% post-traumatic HFS and 4% secondary to an eye injury. Stress was found in 17% of patients.

DISCUSSION AND CONCLUSION

This study illustrates the need for MRI with attention to the posterior fossa in the work-up of HFS in order to identify primary HFS associated with vascular compression of the facial nerve and to rule out a rare but serious posterior fossa tumor. The treatment of HFS is based on quarterly injections of botulinum neurotoxin/A (NTBo/A), the three brands of which have market approval. The injection pattern and frequency is customized according to the results. In cases of insufficient response to injections of NTBo/A, neurosurgical microvascular decompression may be considered for cases of primary HFS.

Use and outcomes of the PK Papyrus covered stent in France: SOS PK Papyrus Registry

OBJECTIVES

To evaluate the rate of procedural success and long-term outcomes of the PK Papyrus (PKP) covered stent (CS).

BACKGROUND

CS are essential in the treatment of coronary artery perforation (CAP). They have also been used to treat coronary artery aneurysms. Limited evidence is available on clinical outcomes with the PKP.

METHODS

This was a multicenter, observational, retrospective, and prospective study. Consecutive patients undergoing intentional PKP implantation in 22 centers in France were included. The primary endpoint was the rate of procedural success. Secondary endpoints included rates of death, myocardial infarction (MI), target lesion revascularization (TLR), in-stent restenosis (ISR), and stent thrombosis (ST).

RESULTS

Data from 130 patients were analyzed (mean age 72.5 ± 10.5 years; 71% men). The main indication for PKP was CAP, in 84 patients (65%). Delivery success was achieved in 95% and procedural success in 91%. During the in-hospital stay, 15 patients died (12%) and 7 (5%) presented with ST. Data from 127 patients were available at 19.2 ± 12.8 month follow-up. Thirty-three patients died (26%), 15 (12%) had an MI and 21 (17%) presented with TLR. TLR was due to ISR in 12 patients (9%), 10 had definite ST (8%) and 1 patient for stent under-expansion.

CONCLUSIONS

The principal indication for PKP was CAP. PKP had high rates of delivery and procedural success. At long-term follow-up, there was a high rate of TLR, mainly due to ISR and ST. These results are consistent with previously reported data in these clinical settings.

[Blepharospasm, dry eye and extractable nuclear antigen antibodies (French translation of the article)]

PURPOSE

The goal of this study is to determine a link between benign essential blepharospasm and Sjogren's syndrome by analyzing the presence of extractable nuclear antigens in this population.

METHODS

Seventy-two patients with benign essential blepharospasm (BEB) were included in this study. We eliminated patients with hemifacial spasm or blepharospasm secondary to corneal pathology. We collected the values of the Schirmer I test and the results of the anti-SSA and anti-SSB antibodies.

RESULTS

Our study included 72 patients (144 eyes) whose 62 women (86.1%). Mean age was 74.3 years±10.73. Average Schirmer I test was 3.14mm±4.00mm. Five women (8% of this female population) had positive anti-SSA and SSB antibodies. Their mean age was 65.66 years±13.24 whereas the negative antibody patients had an average age of 75.42±9.27. There was no significant difference between their Schimer I test and the Schirmer I of negative antibody population.

CONCLUSION

This study illustrates the possible association between the presence of Sjögren's syndrome and the occurrence of a BEB justifying the search for anti-SSA and anti SSB in blepharospasm patients.

Ambulatory TAVR: Early Feasibility Experience During the COVID-19 Pandemic

The COVID-19 pandemic has modified practice for patients with symptomatic aortic stenosis and could result in higher mortality rates due to treatment delays. In this clinical case series, 3 patients underwent ambulatory transcatheter aortic valve replacement (TAVR) thanks to patient and entourage willingness, careful patient selection (including a history of permanent pacemaker placement), and a minimalist procedural approach. No complications occurred during the 30-day follow-up. Performing ambulatory TAVR could reduce the clinical consequences of wait times, minimize exposure to coronavirus contamination, and reduce the use of hospital resources that might be needed for COVID-19 patients. Thanks to a scrupulous minimalist TAVR protocol, ambulatory outpatient management of aortic stenosis was possible in the context of the COVID-19 pandemic.

Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus

We present a rare case of cavernous sinuses air embolism occurring after peripheral venous catheterization. This 44-year-old lady followed for idiopathic thrombocytopenic purpura was referred to our service for vomiting and critical headaches after blood transfusion for her thrombocytopenia. Having been submitted to a brain computed tomography, this later showed air bubbles in bilateral cavernous sinuses related to cavernous sinuses gas embolism. This condition, which remains purely unusual could be fatal, where the ultimate importance that the radiologists and clinicians to be fully aware of.

Evaluation of emotional disorders before and during treatment with interferon beta in patients with multiple sclerosis

BACKGROUND

Domains encompassing emotional disorders in relapsing-remitting MS (RRMS) patients are still unclear.

METHODS

We performed a 24-month, multicenter, single-arm, prospective study. RRMS patients started IFN-β treatment at baseline. The primary endpoint was lack of emotional control, measured using the "Echelle d'HumeurDépressive" (EHD) scale three times at baseline and at 10 post-treatment visits. Secondary endpoints were emotional blunting, irritability, fatigue, depression and anxiety. A linear mixed covariance model assessed change from baseline on an intention-to-treat basis, under the assumption of no mood disorder effect (one-sided 97.5% level), in which autoregressive type of autocorrelation was tested.

RESULTS

Out of 79 recruited patients, 70 were analyzed: 80% female; mean (SD) age, 37.0 (11.5) years. Mean (SD) lack of emotional control score at baseline and Month 24 was 12.7 (4.4) and 12.6 (5.5), respectively, versus 10.1 (3.2) in a healthy control population matched for age and sex. Stepwise analysis identified younger age, male sex and antidepressant use as significant predictors of higher lack of emotional control values.

CONCLUSIONS

Based on 24 months of prospective follow-up, the results of this study highlights a broad spectrum of emotional disorders in the MS population at the time of disease modifying drugs initiation but no major IFN-β-related emotional disorders (mood dyscontrol, anxiety, depression) were observed. However, sporadic occurrences of severe mood disorders and suicidality cannot be excluded.

Blepharospasm, dry eye and extractable nuclear antigen antibodies

PURPOSE

To study whether there is an association between benign essential blepharospasm and Sjögren's syndrome by analyzing the presence of antibodies to extractable nuclear antigens in this population.

METHODS

Seventy-two patients with benign essential blepharospasm (BEB) were included in this study. We excluded patients with hemifacial spasm or blepharospasm secondary to known corneal pathology. We recorded results of Schirmer I testing as well as levels of anti-SSA/Ro and anti-SSB/La antibodies.

RESULTS

Our study included 72 patients (144 eyes), of which 62 (86.1%) were women. The mean age was 74.3±10.73 years. The mean Schirmer I test result was 3.14±4.00mm. Five women (8% of this female population) were found to have positive anti-SSA/Ro and anti-SSB/La antibodies. Their mean age was 65.66±13.24 years, while the mean age of the antibody-negative patients was 75.42±9.27 years. There was no statistically significant difference between the Schirmer I tests of the antibody positive and negative patients.

CONCLUSION

This study demonstrates a possible association between Sjögren's syndrome and benign essential blepharospasm, justifying anti-SSA/Ro and anti-SSB/La testing in these patients.

Polymer-free drug-coated vs. bare-metal coronary stents in patients undergoing non-cardiac surgery: a subgroup analysis of the LEADERS FREE trial

AIMS

To compare the outcomes of patients undergoing non-cardiac surgery (NCS) after PCI with either a drug-coated stent (DCS) or a bare-metal stent (BMS), followed by 1-month dual antiplatelet therapy and to explore the impact of the timing of NCS.

METHODS

This is a subgroup analysis of the LEADERS FREE trial. The primary safety end point was a composite of cardiac death, myocardial infarction, or stent thrombosis, and the primary efficacy end point was clinically driven target lesion revascularization (TLR).

RESULTS

Out of 2432 patients included in the LEADERS FREE trial, 278 (11.4%) underwent NCS within 1 year after PCI. Among NCS patients, the 1-year safety end point was numerically lower with DCS; however, this difference was not significant as compared to BMS (4.7% vs. 10.1%, HR: 0.459 [0.178-1.183], p = 0.099), clinically driven TLR was significantly lower after DCS (2.4% vs. 8.3%, HR: 0.281 [0.079-0.996], p = 0.036), and BARC 3-5 bleeding was similar with DCS vs. BMS (10.2% vs. 7.5%, p = 0.438). In patients treated with BMS, NCS within 3 months after PCI was associated with higher incidence of the safety end point than NCSs performed later: 14.9% vs. 4.4%, HR: 3.586 [1.012-12.709], p = 0.034. The timing of surgery had no impact on patients treated with DCS (4.7% vs. 4.7%, p = 0.947).

CONCLUSIONS

Among patients undergoing NCS after PCI, DCS-treated patients had a lower probability of clinically driven TLR compared with BMS. However, there was no significant difference in the occurrence of the primary composite safety end point or bleeding complications. Early NCS after BMS-PCI was associated with impaired safety, while the timing of NCS had no such influence after DCS implantation.

Transcoronary Rapid Pacing Solving a Complex Retrograde Chronic Total Occlusion Procedure

We report a case of revascularization of the right coronary artery via the epicardial collateral, for which we used transcoronary rapid pacing to obtain cardiac standstill while puncturing the distal chronic total occlusion (CTO) cap. To our knowledge, this is the first case in which this technique has been used in CTO. (Level of Difficulty: Advanced.)

[Best conditions to perform TAVI procedures]

Well conditions to perform TAVI procedures are guided by ministry regulation and dedicated to centers with both on-site a cath-lab and cardiac surgery. Heart Team decision is mandatory to select patient for TAVI and local anesthesia is recommended. Conditions changes would be discuss according to increased procedures number related to indications evolution.

Imagerie de l'encéphalomyélite aiguë disséminée: étude de 22 cas

L'Encéphalomyélite aiguë disséminée (ADEM) est une cause rare d'encéphalite de l'adulte, caractérisée par des lésions inflammatoires de la substance blanche du système nerveux central (SNC). Le tableau clinique initial peut mimer un tableau sévère d'infection du SNC avec fièvre, encéphalopathie, crises convulsives, ou un tableau de sclérose en plaque. Le but de notre travail est de rapporter les caractéristiques épidémiologiques, cliniques, radiologiques, thérapeutiques et évolutives de l'ADEM, aussi évaluer l'apport des séquences IRM dans le diagnostic, le suivi et le pronostic de la maladie. Il s'agit d'une étude rétrospective des dossiers cliniques et radiologiques d'ADEM sur 11 ans (janvier 2006-janvier 2017) portant sur 22 cas suivis au service de neurologie et explorés au niveau du service d'imagerie médicale de l'Hôpital Militaire d'Instruction Mohammed V de Rabat. L'âge moyen des patients était de 35 ans [12-57ans]. Une notion d'infection récente était retrouvée dans 31%, une vaccination récente dans 4%. La symptomatologie était dominée par un déficit neurologique focal avec un pourcentage de 72%. La TDM était normale dans 78%. L'IRM a montré un hyper signal FLAIR de la SB sus et sous tentoriel dans 70%, sans restriction de la diffusion dans la totalité des cas, avec rehaussement des lésions dans 27%, l'atteinte de la moelle cervicale estimait à 68%. L'évolution clinique et radiologique était favorable dans la totalité des cas.