Endovascular retrieval of a migrated contraceptive implant into the pulmonary artery : case report and review of literature

BACKGROUND

The migration of contraceptive devices into pulmonary arteries is extremely rare, reported to be 1 in 100,000.

CASE PRESENTATION

A 19-year-old female presented no sensation of a contraceptive implant in her arm which had been placed one year prior. A CT scan confirmed that the implant had migrated into the left lower segmentary pulmonary artery. After a multidisciplinary meeting, an endovascular approach was attempted. Following right femoral venous access, a 8F NeuronMax® introducer was placed into the left pulmonary artery under fluoroscopic guidance. The contraceptive device was removed using a 25-mm loop snare, with a proximal capture technique. The patient was discharged the following day, with no reported complications.

CONCLUSION

In cases of contraceptive device migration, the first medical decision involves deciding between removal or 'watching and waiting'. Previous reports describe two removal options: endovascular or surgical approaches. Fourteen reports have been published, with high technical success and low rates of complications. The loop snare technique is described as the optimal technique for an endovascular approach. Due to their invasive nature, surgical approaches should be reserved for cases of endovascular removal failure, after evaluating risks and benefits.

Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence

BACKGROUND

Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center.

METHODS

Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011-2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS.

RESULTS

Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1-4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5-8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5-10.1) and 34.1 months (95% CI 28.1-53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2-16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08-13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67-175.44], p < 0.001) was independently associated with poor OS.

CONCLUSIONS

In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.

Performance of a Region of Interest-based Algorithm in Diagnosing International Society of Urological Pathology Grade Group ≥2 Prostate Cancer on the MRI-FIRST Database-CAD-FIRST Study

BACKGROUND AND OBJECTIVE

Prostate multiparametric magnetic resonance imaging (MRI) shows high sensitivity for International Society of Urological Pathology grade group (GG) ≥2 cancers. Many artificial intelligence algorithms have shown promising results in diagnosing clinically significant prostate cancer on MRI. To assess a region-of-interest-based machine-learning algorithm aimed at characterising GG ≥2 prostate cancer on multiparametric MRI.

METHODS

The lesions targeted at biopsy in the MRI-FIRST dataset were retrospectively delineated and assessed using a previously developed algorithm. The Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) score assigned prospectively before biopsy and the algorithm score calculated retrospectively in the regions of interest were compared for diagnosing GG ≥2 cancer, using the areas under the curve (AUCs), and sensitivities and specificities calculated with predefined thresholds (PIRADSv2 scores ≥3 and ≥4; algorithm scores yielding 90% sensitivity in the training database). Ten predefined biopsy strategies were assessed retrospectively.

KEY FINDINGS AND LIMITATIONS

After excluding 19 patients, we analysed 232 patients imaged on 16 different scanners; 85 had GG ≥2 cancer at biopsy. At patient level, AUCs of the algorithm and PI-RADSv2 were 77% (95% confidence interval [CI]: 70-82) and 80% (CI: 74-85; p = 0.36), respectively. The algorithm's sensitivity and specificity were 86% (CI: 76-93) and 65% (CI: 54-73), respectively. PI-RADSv2 sensitivities and specificities were 95% (CI: 89-100) and 38% (CI: 26-47), and 89% (CI: 79-96) and 47% (CI: 35-57) for thresholds of ≥3 and ≥4, respectively. Using the PI-RADSv2 score to trigger a biopsy would have avoided 26-34% of biopsies while missing 5-11% of GG ≥2 cancers. Combining prostate-specific antigen density, the PI-RADSv2 and algorithm's scores would have avoided 44-47% of biopsies while missing 6-9% of GG ≥2 cancers. Limitations include the retrospective nature of the study and a lack of PI-RADS version 2.1 assessment.

CONCLUSIONS AND CLINICAL IMPLICATIONS

The algorithm provided robust results in the multicentre multiscanner MRI-FIRST database and could help select patients for biopsy.

PATIENT SUMMARY

An artificial intelligence-based algorithm aimed at diagnosing aggressive cancers on prostate magnetic resonance imaging showed results similar to expert human assessment in a prospectively acquired multicentre test database.

MRI in rectal cancer: An institutional real life analysis of technical parameters

INTRODUCTION

MRI plays a key role in the preoperative staging of rectal cancers and choice of neoadjuvant radiochemotherapy. Yet, the acquisition and interpretation of rectum magnetic resonance imaging (MRI) turn out to be unequal, impacting patients'care. The present study aims at evaluating the quality of the acquisition of technical parameters of the rectal MRI performed by comparing them according to the various guidelines.

METHODS

The medical MRI reports of all consecutive patients with locally advanced rectal cancer treated in a curative intent, by preoperative RCT and completion surgery were retrospectively reviewed over two periods (January 2010-December 2014 and January 2018 and December 2020) according to international 2012 and 2016 ESGAR and 2017 SAR MRI recommendation reports.

RESULTS

During the first period (69 MRI performed), 58% of these MRI abided by the recommendations and 75% of essential criteria could be found in 25.5% of MRI reportings. During the second period (73 MRI performed), the protocol used by 6.8% of MR images abided by the 2016 Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations and 39.7% abided by the Society of Abdominal Radiology (SAR) recommendations. 75% of essential criteria could be found in 52.3% of MRI reportings and 90% of essential criteria could be found in 6.2% of MRI reportings.

DISCUSSION

In an era of increasing individualized patient care and conservative treatment focused on tumour response and prognostic factors, the present study showed that compliance to MRI protocols and reporting guidelines needs improving to upgrade patient care.

Evaluation of preventive tract embolization with standardized gelatin sponge slurry on chest tube placement rate after CT-guided lung biopsy: a propensity score analysis

BACKGROUND

To evaluate the effect of tract embolization (TE) with gelatin sponge slurries during a percutaneous lung biopsy on chest tube placement and to evaluate the predictive factors of chest tube placement.

METHODS

Percutaneous CT-guided lung biopsies performed with (TE) or without (non-TE) tract embolization or between June 2012 and December 2021 at three referral tertiary centers were retrospectively analyzed. The exclusion criteria were mediastinal biopsies, pleural tumors, and tumors adjacent to the pleura without pleural crossing. Variables related to patients, tumors, and procedures were collected. Univariable and multivariable analyses were performed to determine risk factors for chest tube placement. Furthermore, the propensity score matching analysis was adopted to yield a matched cohort.

RESULTS

A total of 1157 procedures in 1157 patients were analyzed, among which 560 (48.4%) were with TE (mean age 66.5 ± 9.2, 584 men). The rates of pneumothorax (44.9% vs. 26.1%, respectively; p < 0.001) and chest tube placement (4.8% vs. 2.3%, respectively; p < 0.001) were significantly higher in the non-TE group than in the TE group. No non-targeted embolization or systemic air embolism occurred. In the whole population, two protective factors for chest tube placement were found in univariate analysis: TE (OR 0.465 [0.239-0.904], p < 0.05) and prone position (OR 0.212 [0.094-0.482], p < 0.001). These data were confirmed in multivariate analysis (p < 0.001 and p < 0.0001 respectively). In the propensity matched cohort, TE reduces significatively the risk of chest tube insertion (OR = 0.44 [0.21-0.87], p < 0.05).

CONCLUSIONS

The TE technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy.

CRITICAL RELEVANCE STATEMENT

The tract embolization technique using standardized gelatin sponge slurry reduces the need for chest tube placement after percutaneous CT-guided lung biopsy.

KEY POINTS

1. Use of tract embolization with gelatine sponge slurry during percutaneous lung biopsy is safe. 2. Use of tract embolization significantly reduces the risk of chest tube insertion. 3. This is the first multicenter study to show the protective effect of tract embolization on chest tube insertion.

The level of glucose in pancreatic cyst fluid is more accurate than carcinoembryonic antigen to identify mucinous tumors: A French multicenter study

Background and Objectives

Pancreatic cyst fluid level of glucose is a promising marker to identify mucinous from nonmucinous tumors, but the glucose assay has not yet been recommended. The objective of this study is to compare the diagnostic performances of pancreatic cyst fluid level of glucose and carcinoembryonic antigen (CEA).

Methods

In this French multicenter study, data of consecutive patients who underwent fine-needle aspiration of pancreatic cyst with intracyst glucose assay between 2018 and 2022 were retrospectively reviewed. The area under the receiver operating characteristic curve (AUROC) of glucose and corresponding sensitivity (Se), specificity (Sp), accuracy (Acc), positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared with those of CEA. The best threshold of glucose was identified using the Youden index.

Results

Of the 121 patients identified, 81 had a definitive diagnosis (46 mucinous, 35 nonmucinous tumors) and were included for analysis. An intracystic glucose level <41.8 mg/dL allowed identification of mucinous tumors with better diagnostic performances (AUROC, 93.6%; 95% confidence interval, 87.2%-100%; Se, 95.3%; Sp, 91.2%; Acc, 93.5%; PPV, 93.2%; NPV, 93.9%) compared with CEA level >192 ng/mL (AUROC, 81.2%; 95% confidence interval, 71.3%-91.1%; Se, 41.7%; Sp, 96.9%; Acc, 67.6%; PPV, 93.8%; NPV, 59.6%) (P = 0.035). Combining values of glucose and CEA did not offer additional benefit in terms of diagnosis.

Conclusion

Our results confirm previously published data and support the use of pancreatic cyst fluid glucose for the identification of mucinous tumors when the definitive diagnosis remains uncertain.

Temporary inferior vena cava filters factors associated with non-removal

OBJECTIVES

Inferior vena cava filter (IVCF) placement is indicated when there is a deep vein thrombosis and/or a pulmonary embolism and a contraindication of anticoagulation. Due to the increased risk of recurrent deep venous thrombosis when left in place, IVCF removal is indicated once anticoagulant treatment can be reintroduced. However, many temporary IVCF are not removed. We aimed to analyze the removal rate and predictors of filter non-removal in a university hospital setting.

METHODS

We collected all the data of consecutive patients who had a retrievable IVCF inserted at the Saint-Etienne University Hospital (France) between April 2012 and November 2019. Rates of filter removal were calculated. We analyzed patient characteristics to assess factors associated with filter non-removal, particularly in patients without a definitive filter indication. The exclusion of this last category of patients allowed us to calculate an adjusted removal rate.

RESULTS

The overall removal rate of IVCF was 40.5% (IC 95% 35.6-45.6), and the adjusted removal rate was 62.9 % (IC 95% 56.6-69.2%). No major complications were noted. Advanced age (p < 0.0001) and cancer presence (p < 0.003) were statistically significant predictors of patients not being requested to make a removal attempt.

CONCLUSIONS

Although most of the filters placed are for therapeutic indications validated by scientific societies, the removal rate in this setting remains suboptimal. The major factors influencing IVCF removal rate are advanced age and cancer presence.

KEY POINTS

• Most vena cava filters are placed for therapeutic indications validated by scientific societies. • Vena cava filter removal rates in this setting remain suboptimal. • Major factors influencing IVCF removal rate are advanced age and cancer presence.

Cavernous Sinus Thrombosis Linked to COVID-19 Infection: a Case Report

The severity of SARS-CoV-2 virus infection is mainly related to its respiratory complications. However, it can also lead to a large variety of thromboembolic events. Symptoms may include headache, fever, and neurological disorders. Since 2020, the clinical presentation of COVID-19 infection has become increasingly varied, leading in some cases to complex symptom associations, including numerous neurological symptoms. SARS-CoV-2 may lead to neurotropism which could reach the central nervous system and all cranial nerves. Cavernous sinus thrombosis is a rare condition and may occur as a complication of ear, nose, and throat (ENT) or facial infections. A 73-year-old man without personal or family history of thrombosis was referred to the emergency room for a sudden appearance of diplopia and ptosis, 3 days after testing positive for COVID-19 infection. An initial head CT-scan found no signs of stroke. He underwent a cerebral MRI 7 days later, which revealed a thrombosis of his right cavernous sinus. A brain CT scan 7 days later showed regression of the thrombosis with complete recanalization of the cavernous sinus. This was accompanied by a complete regression of diplopia and fever. He was discharged from the hospital 10 days after hospital admission. In this case report, we describe a rare event of cavernous thrombophlebitis following a COVID-19 infection.

Uterine transarterial embolization as nonsurgical management for uterine rupture following vaginal delivery: A report of two cases

Uterine rupture (UR) is an unexpected, rare, and serious obstetrical condition, occurring in less than 0.1% of pregnancies. Complete UR is defined as a direct communication between the uterine cavity and the peritoneum due to a complete rupture of the myometrium. Here, we present 2 cases of non-surgical management of UR following vaginal delivery, which were both treated by uterine transarterial embolization (UAE). A 26-year-old woman (G0P0) was referred to the emergency ward at 35 weeks of amenorrhea to treat the rupture of membranes, in the context of twin pregnancy. A vaginal delivery was performed and blood loss exceeded 2 liters. Gelatin sponge was injected in an attempt to occlude the right uterine artery. The injection was unsuccessful. After the medical team's discussion, it was decided to definitively occlude the right uterine artery. A 37-year-old woman (G3P3) was referred for a vaginal delivery for a medical termination at 38 weeks of amenorrhea. The ultrasound revealed a left latero-uterine pelvic hematoma, suggestive of UR. Four fibered coils were used to definitively occlude the left uterine artery. Computed tomography scan showed a progressive resorption of hematoma and satisfactory enhancement of the uterine wall in the 2 cases. Transarterial embolization may allow for bleeding to stop without resorting to exploratory laparotomy, with ad-integrum restitution of the uterine wall, and thus prevent a potential hysterectomy. The findings in these 2 cases suggest that UAE should be considered if pregnant women develop UR after delivery.

Transarterial Embolization for Active Gastrointestinal Bleeding: Predictors of Early Mortality and Early Rebleeding

Background: The aim of this study was to determine predictive factors of early mortality and early rebleeding (≤30 days) following transarterial embolization (TAE) for treatment of acute gastrointestinal bleeding. Methods: All consecutive patients admitted for acute gastrointestinal bleeding to the interventional radiology department in a tertiary center between January 2012 and January 2022 were included. Exclusion criteria were patients: (1) aged < 18-year-old, (2) referred to the operation room without TAE, (3) treated for hemobilia, (4) with mesenteric hematoma, (5) lost to follow-up within 30 days after the procedure. We evaluated pre and per-procedure clinical data, biological data, outcomes, and complications. Results: Sixty-eight patients were included: 55 (80.9%) experienced upper gastrointestinal bleeding and 13 (19.1%) lower gastrointestinal bleeding. Median age was 69 (61−74) years. There were 49 (72%) males. Median hemoglobin was 7.25 (6.1−8.3) g/dL. There were 30 (50%) ulcers. Coils were used in 46 (67.6%) procedures. Early mortality was 15 (22.1%) and early rebleeding was 17 (25%). In multivariate analysis, hyperlactatemia (≥2 mmol/L) were predictive of early mortality (≤30 days). A high number of red blood cells units was associated with early rebleeding. Conclusion: This study identified some predictive factors of 30-day mortality and early rebleeding following TAE. This will assist in patient selection and may help improve the management of gastrointestinal bleeding.

Combination of Percutaneous Screw Fixation and Cementoplasty for Lytic Bone Metastases: Feasibility, Safety and Clinical Outcomes

OBJECTIVE

To evaluate feasibility, safety and efficacy of a combination of screw fixation and cementoplasty for pathologic bone fracture.

METHODS

In this single-center prospective study, all consecutive percutaneous screw fixations under assisted CT guidance for palliation and fracture treatment of pathologic bone fracture were reviewed from July 2019 to February 2021. The primary outcome measure was the procedures' technical success, defined as the correct placement of the screw(s), without any complications. Secondary outcome measures were the safety, the procedures' early analgesic effects and impacts on quality of life at 4 weeks.

RESULTS

Technical success was achieved in 11/11 procedures (100%) among 11 patients. No major complications attributable to the procedure were noted. The mean pain scored significantly decreased at the initial follow-up: 8.0 ± 2.7 versus 1.6 ± 2.5 (p < 0.05). Opioid doses were statistically lower after procedure: 70.9 ± 37 versus 48.2 ± 46 mg/day (p < 0.05). The mean EQ5D score had significantly increased by the early post-procedure consultation: 42.5 ± 13.6 vs 63.6 ± 10.3 (p < 0.05).

CONCLUSION

Combination of percutaneous screw fixation and cementoplasty for pathologic bone fracture is feasible and safe. It is efficient to reduce pain, decrease the consumption of opioids and improve the quality of life at 4 weeks after the procedure.

Preventive tract embolization with gelatin sponge slurry is safe and considerably reduces pneumothorax after CT-guided lung biopsy with use of large 16-18 coaxial needles

OBJECTIVE

To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy.

METHODS

We retrospectively compared coaxial needle CT-guided lung biopsies performed without embolization (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni- and multivariate analyses were performed between groups to determine risk factors of pneumothorax.

RESULTS

Patients with gelatin sponge slurry tract embolization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17-0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14-0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44-8.21 p = 0.006 and OR = 4.36 CI = 1.98-10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12-0.51, p < 0.001). The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively).

CONCLUSIONS

The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine.

ADVANCES IN KNOWLEDGE

The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16-18G coaxial needles.

Internal border zone injury predicts the functional outcome of acute MCA stroke patients

BACKGROUND AND PURPOSE

Classification of deep (D), superficial (S) MCA territories and their junctional vascular area (the internal border zone, IBZ) can help to identify patients most likely to benefit from aggressive reperfusion therapy after stroke. We tested the prognostic value of an IBZ injury compared to DWI-ASPECTS and infarct volume.

MATERIALS AND METHODS

DW lesions of 168 patients with acute (4.2±6.5 h) MCA strokes were retrospectively examined and manually delineated. Patients with haemorrhagic transformation or other neurological diseases were excluded. Clinical data were recorded within 24 h following symptom onset and 48 h for patients who benefited from reperfusion therapy. The occurrence of an IBZ injury was determined using a standardized stereotaxic atlas. Performance to predict a good outcome (mRS<3 at 3 months) was estimated through ROC curves for DWI-ASPECTS≤6, lesion volume≥100 mL and IBZ injury. Logistic regression models were performed to estimate independent outcomes for infarct volume and IBZ injury.

RESULTS

Infarcts involving the IBZ were larger (94.9±98.8 mL vs. 30.2±31.3 mL), had higher NIHSS (13.8±7.2 vs. 7.2±5.7), more frequent MCA occlusions (64.9% vs. 28.3%), and worse outcomes (mRS 3.0±1.8 vs. 1.9±1.7), and were less responsive to IVtPA (34±47% vs. 55±48% of NIHSS improvement). The area under the ROC curves was comparable between the occurrence of IBZ injury (0.651), ASPECTS≤6 (0.657) and volume≥100 mL (0.629). Logistic regression analyses showed an independent effect of an IBZ injury, especially for superficial MCA strokes and for patients who benefited from reperfusion therapy.

CONCLUSION

An IBZ injury is an early and independent marker of stroke severity, functional prognosis and treatment responsiveness.

815 FRAILTY AND MULTIMORBIDITY ARE ASSOCIATED WITH LONGER LENGTH OF STAY IN OLDER UROLOGY PATIENTS

Introduction

Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in older patients admitted for emergency Urology care.

Methods

Adults aged 65 years and older admitted as an emergency to the Urology service during 4 months of 2020/21 were included. The primary outcome was time to discharge; analyses were adjusted for Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), age, gender, and surgical procedure (yes/no).

Results

142 patients were included, of these 60 (42.3%) were living with frailty (CFS ≥5), 32 (22.5%) were multimorbid and 59 (41.5%) underwent a surgical procedure. Longer length of stay was associated with frailty (adjusted-HR 0.560; 95% CI 0.376–0.835; p 0.004) and multimorbidity (adjusted-HR 0.556; 95% CI 0.367–0.842; p 0.006).

Conclusion

In this single-centre study we found frailty and multimorbidity to be associated with longer length of stay in patients admitted for emergency Urology care. Geriatric perioperative care interventions in other surgical specialties have been shown to reduce length of stay, the effect of such services within urology has yet to be established. Identification of frail and multimorbid patients could help to develop targeted strategies to improve outcomes, and ultimately reduce hospital stay.

812 GERIATRIC PERIOPERATIVE CARE IS ASSOCIATED WITH REDUCED LENGTH OF STAY IN UROLOGY PATIENTS

Introduction

Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outcomes can be repeated in other urological centres.

Method

We piloted a Geriatric Perioperative Care service delivering CGA to older emergency urology patients admitted to within a tertiary centre. The aim of the service was to reduce length of hospital stay (LOS). We evaluated it using quality improvement methodology. Patients for review were identified using age ≥ 65 and the Clinical Frailty Scale. Patients that were transferred to another hospital team prior to discharge were excluded.

Results

101 patients were included: 35 in the pre-intervention group and 66 in the post-intervention group. Mean LOS in the pre-intervention group was 7 days. In the post-intervention group, mean LOS was reduced to 3.5 days, 6 days and 5.5 days in the first, second and third months respectively.

Conclusion

We found that perioperative geriatric care was associated with reduced length of stay in older urology patients. These data would support the need for larger and/or multicentre studies to evaluate the relationship between geriatric intervention in urological inpatients and length of hospital stay. References: on request due to word count.

Safety and efficacy of emergency transarterial embolization for mesenteric bleeding

Background

Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications.

Results

Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications.

Conclusion

Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Pulmonary Involvement Responsive to Enzyme Replacement Therapy in an Elderly Patient with Gaucher Disease

Type 1 Gaucher disease (GD) is a rare autosomal recessive lysosomal storage disorder caused by deficient activity of beta-glucocerebrosidase, leading to accumulation of its substrate (glucosylceramide) in macrophages of the reticuloendothelial system, which are then referred to as Gaucher cells. The most frequent symptoms are asthenia, spleen and liver enlargement, bone abnormalities and cytopenia due to bone marrow infiltration. Lung involvement in GD is a rare finding, and it is unclear whether it may regress under enzyme replacement therapy (ERT) or substrate reduction therapy (SRT). Here we report a case of type 1 GD recently diagnosed in an elderly patient complicated by infiltrative lung disease, which responded to ERT.

LEARNING POINTS

Type 1 Gaucher disease (GD) is the most common type of GD diagnosed in adulthood, and is characterized by great clinical heterogeneity.Pulmonary involvement is rare, mostly characterized by infiltrative lung disease and pulmonary hypertension, and typically unresponsive to enzyme replacement therapy (ERT).Type 1 GD should be included in the differential diagnosis of infiltrative lung disease of unclear origin in patients with cytopenia and/or splenomegaly.Infiltrative lung disease due to type 1 GD may respond to ERT even in elderly patients.

CT-guided percutaneous approach for the treatment of peripheral pulmonary artery pseudoaneurysm: A case report

Pulmonary artery pseudoaneurysm is a rare but life threatening complication of pulmonary tuberculosis, considered as a diagnosis and therapeutic emergency. Transarterial embolization approach has become more widespread over the last few decades, and is now considered the first-line treatment over surgery. Percutaneous embolization under computed tomography (CT) or CT scan control has recently been reported by one centre as a first-line treatment for persistent peripheral Pulmonary artery pseudoaneurysm under certain conditions. We report the case of a 23-year-old female patient admitted in emergency for moderate haemoptysis, in a context of relapsing of tuberculosis. CT scan angiogram showed a peripheral pulmonary artery pseudoaneurysm of the lower left lobe, and persisted seven days later. After multidisciplinary meeting, a minimal invasive approach was decided. The patient was treated in first-line treatment by percutaneous transthoracic embolization, under CT-guidance, using N butyl-cyanoacrylate and Lipiodol mixture, without any complication. The percutaneous minimal invasive treatment seems to be a reliable approach to treat persistent peripheral pulmonary artery pseudoaneurysm.

Spinal Arachnoid Web: A didactic report of two cases with clinical, radiological, surgical and pathological correlations

BACKGROUND

Arachnoid web (AW) is a rare but probably underestimated cause of spinal cord injury that is complex to diagnose due to subtle MRI findings and similarities to other better-known diseases such as arachnoid cyst (AC) or transdural spinal cord herniation (TSCH). Increased recognition of AW is mandatory since delay in diagnosis can lead to potentially serious neurological sequelae.

CASE PRESENTATIONS

We report two additional cases of AW for didactic purposes, with special emphasis on the distinctive MRI and intraoperative findings. Both patients presented with progressively worsening neurological symptoms, including proprioceptive ataxia, motor weakness, numbness and neuropathic pain. The diagnosis of AW was suspected on the basis of specific MRI criteria, especially the so-called "scalpel sign". Formal confirmation of the diagnosis was obtained in two patients that were managed surgically. Postoperative follow-up demonstrated significant functional recovery.

DISCUSSION

There is a need for better recognition of AW by the medical community. Careful analysis of MRI semiology is crucial for the distinction between AW, AC and TSCH. Prompt and accurate diagnosis is mandatory to conserve functional prognosis, since appropriate surgical treatment with AW resection is curative, halting or even resolving the neurological symptoms.

Delayed superior epigastric artery pseudoaneurysm following percutaneous radiologic gastrostomy: Treatment by percutaneous embolization with N-butyl cyanoacrylate

Percutaneous radiologic gastrostomy (PRG) is a widely used procedure with a low rate of serious complications and with comparable short-term outcomes with percutaneous endoscopy. Hemorrhagic complications are rare (1.4%), and occur usually immediately after the procedure due to direct arterial punctures. We report on the case of a 62-year-old male patient with a diagnosis of multi-systemic atrophy disease that was referred to our tertiary center for PRG. The procedure was performed without early complications. He presented a slight bleeding 3 weeks of the procedure. A CT angiogram revealed a pseudoaneurysm of the left superior epigastric artery, in contact with the gastrostomy tube. After a failed surgical treatment, the patient was successfully treated by percutaneous embolization using a mixture of Glubran 2 and Lipiodol, under ultrasound and fluoroscopic control. This case study suggested that a slight hemorrhage following PRG may suggest a pseudoaneurysm and a CT angiogram should be performed.

Quantitative Magnetic Resonance Imaging Assessment of the Quadriceps Changes during an Extreme Mountain Ultramarathon

INTRODUCTION/PURPOSE

Extreme ultra-endurance races are growing in popularity, but their effects on skeletal muscles remain mostly unexplored. This longitudinal study explores physiological changes in mountain ultramarathon athletes' quadriceps using quantitative magnetic resonance imaging (MRI) coupled with serological biomarkers. The study aimed to monitor the longitudinal effect of the race and recovery and to identify local inflammatory and metabolic muscle responses by codetection of biological markers.

METHODS

An automatic image processing framework was designed to extract imaging-based biomarkers from quantitative MRI acquisitions of the upper legs of 20 finishers at three time points. The longitudinal effect of the race was demonstrated by analyzing the image markers with dedicated biostatistical analysis.

RESULTS

Our framework allows for a reliable calculation of statistical data not only inside the whole quadriceps volume but also within each individual muscle head. Local changes in MRI parameters extracted from quantitative maps were described and found to be significantly correlated with principal serological biomarkers of interest. A decrease in the PDFF after the race and a stable paramagnetic susceptibility value were found. Pairwise post hoc tests suggested that the recovery process differs among the muscle heads.

CONCLUSIONS

This longitudinal study conducted during a prolonged and extreme mechanical stress showed that quantitative MRI-based markers of inflammation and metabolic response can detect local changes related to the prolonged exercise, with differentiated involvement of each head of the quadriceps muscle as expected in such eccentric load. Consistent and efficient extraction of the local biomarkers enables to highlight the interplay/interactions between blood and MRI biomarkers. This work indeed proposes an automatized analytic framework to tackle the time-consuming and mentally exhausting segmentation task of muscle heads in large multi-time-point cohorts.

Successful embolization of giant pulmonary artery pseudoaneurysm using coils and ethylene vinyl alcohol copolymer (Onyx)

Hemoptysis could be a life-threatening event, especially when the bleeding originates from the arterial pulmonary circulation. The main cause of this type of bleeding is pulmonary artery pseudoaneurysm (PAP), which can be managed by surgical, medical or minimally invasive techniques. This study reports the case of massive hemoptysis in a 75-year-old male patient, with a former history of lobectomy. The initial CT scan showed a giant PAP from a branch of the right middle lobar pulmonary artery, within the right lower lobectomy cavity. An endovascular approach was decided. Subsequently, the feeding artery of the PAP was embolized with detachable coils. The control CT scan showed a persistent opacification of the PAP. The embolization was then completed by injection of Onyx within coils packing, with a complete thrombose of the PAP on control CT scan. This report confirms the safety and efficacy profile of an endovascular approach to treat giant PAP, using a combination of coils and Onyx.

Fatal aspergillosis complicating severe SARS-CoV-2 infection: A case report

As aspergillosis is a well-known complication of severe influenza, we suggest that SARS-CoV-2 might be a risk factor for invasive aspergillosis (IA). We report the case of an 87 year-old woman, with no history of immune deficit, admitted in our emergency room for severe respiratory distress. Coronavirus disease 2019 (COVID-19) diagnosis was confirmed by a SARS-CoV-2 reverse transcriptase polymerase chain reaction (PCR) on nasal swab. On day 14, pulmonary examination deteriorated with haemoptysis and a major increase of inflammatory response. A computed tomography (CT) scan revealed nodules highly suggestive of IA. Aspergillus antigen was found highly positive in sputum and blood, as was Aspergillusspp PCR on serum. Sputum cultures remained negative for Aspergillus. This patient died rapidly from severe respiratory failure, despite the addition of voriconazole. Considering SARS-CoV-2 acute respiratory distress syndrome (ARDS) as an acquired immunodeficiency, we report here a new case of "probable" IA based on clinical and biological arguments, in accordance with the last consensus definition of invasive fungal disease. On a routine basis, we have detected 30% of aspergillosis carriage (positive culture and antigen in tracheal secretions) in critically ill patients with COVID-19 in our centre. Further studies will have to determine whether sputum or tracheal secretions should be systematically screened for fungal investigations in intensive care unit (ICU) COVID-19 patients to early diagnose and treat aspergillosis.

Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

Purpose: To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Materials and methods: Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Results: Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ≥ II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m², which was significantly higher among those treated for central tumors (p < .05). Conclusion: Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings.

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (−6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.

Core-shell potassium niobate nanowires for enhanced nonlinear optical effects

We demonstrate the synthesis as well as the optical characterization of core-shell nanowires. The wires consist of a potassium niobate (KNbO3) core and a gold shell. The nonlinear optical properties of the core are combined with the plasmonic resonance of the shell and offer an enhanced optical signal in the near infrared spectral range. We compare two different functionalization schemes of the core material prior to the shell growth process: silanization and polyelectrolyte. We show that the latter leads to a smoother and complete core-shell nanostructure and an easier-to-use synthesis process. A Mie-theory based theoretical approach is presented to model the enhanced second-harmonic generated (SHG) signal of the core-shell wires, illustrating the influence of the fabrication-induced varying geometrical factors of wire radius and shell thickness. A spectroscopic measurement on a core-shell nanowire shows a strong localized surface plasmon resonance close to 900 nm, which matches with the SHG resonance obtained from nonlinear optical experiments with the same nanowire. According to the simulation, this corresponds to a wire radius of 35 nm and a shell thickness of 7.5 nm. By comparing SHG signals measured from an uncoated nanowire and the coated one, we obtain a 250 times enhancement factor. This is less than the calculated enhancement, which considers a cylindrical nanowire with a perfectly smooth shell. Thus, we explain this discrepancy mainly with the roughness of the synthesized gold shell.

Plasmonic heating with near infrared resonance nanodot arrays for multiplexing optofluidic applications

In this work, we show local laser-induced heating in fluids with gold nanodot arrays prepared by electron-beam lithography that cover resonances in the near infrared spectral range from 750 nm to 880 nm.

Holographic gratings for the Far Ultraviolet Spectroscopic Explorer: development, imaging, and efficiency tests of two prototypes

We report on a study and test of two 6000-groove/mm prototype holographic gratings for NASA's FarUltraviolet Spectroscopic Explorer (FUSE) mission. The first grating was designed and developed onthe basis of the FUSE requirements as specified at the end of the first study in 1992. This design relieson an ellipsoidal grating, recorded with aberrated wave fronts to correct sagittal coma. The secondgrating corresponds to the new design adopted after the complete mission was restructured in1993. With this solution a new family of spherical holographic gratings recorded with stigmaticsources was permitted to increase the aperture size while simplifying the figuring and recording of theblank. The design, fabrication, and testing of each prototype are described, and we show that thechallenging requirement of a 30,000 resolving power at 1000 Å, with a 25% groove efficiency, is reached.

Holographic spherical gratings: a new family of quasi-stigmatic designs for the Rowland-circle mounting

In the context of aberration-corrected holographic spherical gratings used in the Rowland-circle mounting, we have investigated the off-Rowland recording geometries with stigmatic sources that nullify the defocus and meridional coma at all wavelengths. We introduce the additional requirement that astigmatism vanishes at a given wavelength. Then we demonstrate that a family of solutions exists and has a quasi-zero sagittal coma at the wavelength adopted for the astigmatism correction. This simultaneous reduction of sagittal coma and astigmatism greatly enhances the spectral performances of the Rowland mount. We also point out that a subfamily is found when the derivative of astigmatism is equal to zero at the wavelength of correction; the performances are then extended to a wider spectral range. Finally ray traces and performances of two representative examples of the new family of gratings are presented.

Aberration-reduced holographic spherical gratings for Rowland circle spectrographs

We used a numerical minimization method to design a Rowland holographic spherical grating that is recorded with two stigmatic laser sources. The method aims at simultaneously reducing all aberrations up to fourth order over a significant spectral range. In the context of a high spectral resolution, far-ultraviolet spectrograph, an original solution is found that implies a nonclassical recording geometry with one virtual source. This solution satisfies the requirement of a resolving power of ~ 30 000 with the unquestionable advantage of manufacturing and testing simplicity. Finally, another example, which is obtained in a different context, shows that the properties of this recording geometry probably have a general applicability.

Holographic diffraction gratings generated by aberrated wave fronts: application to a high-resolution far-ultraviolet spectrograph

We investigated the ability of aberration-corrected concave holographic gratings used in the Rowland mount at normal diffraction to provide high spectral resolution in the far-ultraviolet region. By assuming that astigmatism and spherical aberration are geometrically corrected by an ellipsoid, we show that holography can be used to correct the remaining prominent second-type coma. Stigmatic sources require a laser wavelength that is too far in the ultraviolet for current recording technology. However, at 3336 A a simple compact symmetric mount, which involves two spherical mirrors, can generate aberrated wave fronts that can be used to record a coma-corrected holographic grating. When compared with the equivalent equally spaced straight-groove grating, which requires a modified ellipsoid substrate, holography cancels the additional asymmetrical term of deformation that permits the use of a simpler surface for the substrate. Some areas of potential difficulty in the holographic mounting are briefly analyzed.