Towards multi-phase postmortem CT angiography in children: a study on a porcine model.

PURPOSE: Multi-phase postmortem computed tomography angiography (MPMCTA) is a growing technique, which is standardized for adults. Application of this protocol for a children population is not so well defined. Our study aims to adapt the adult's protocol to children, using a porcine model. MATERIAL AND METHODS: Three groups of 18 pigs were studied, with a weight distribution between 4 and 48 kg. Different pump devices were used. Pigs of group I were studied using the Virtangio® machine, whereas pigs of groups II and III were studied using used the Medrad® machine. Study of vascular opacification was possible using a semi-quantitative method based on 26 arterial and 26 venous segments that were distributed over the entire body from the cephalic extremity to the posterior pawns. RESULTS: While thoracic, abdominal, and pelvic vascular opacification were complete for each individual pig in a group, group III showed better vascular opacification for the cephalic extremity. This was also true for anterior and posterior pawns vascular opacification. Spearman correlation tests showed a significant relationship between anthropometric characteristics of pigs, injection parameters, and percentage of opacified segments. A higher percentage of opacification was obtained for individuals of lower weights, with comparatively lower quantities of contrast agent injected. CONCLUSION: Postmortem computed tomography angiography (PMCTA) was possible for all the individuals, particularly for small weights (4 kg) using the Medrad® machine. However, further studies are needed to better understand the procedure.

Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases.

Corrigendum to: 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases [Eur Heart Journal (2014) 35, 2873­2926,doi:10.1093/eurheartj/ehu281]. In Table 3, the radiation for MRI is "0" and not "-". The corrected table is shown below.

Predictive factors for extended-spectrum beta-lactamase producing Enterobacteriaceae causing infection among intensive care unit patients with prior colonization.

We investigated the predictive factors for extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE) causing infections among intensive care unit patients with prior documented ESBL-PE colonization. Using multivariate analysis, referral from medical ward, nursing home or rehabilitation center [Odds ratio (OR), 2.5; 95 % confidence interval (CI), [1.3-5.0]; p = 0.007], previous fluoroquinolone treatment (OR, 3.4; CI, [1.1-10.5]; p = 0.003), extracorporeal membrane oxygenation (OR, 4.6; CI, [1.3-15.9]; p = 0.02), and absence of prior positive ESBL-PE rectal swab culture (OR, 5.0; CI, [1.6-10.0]; p = 0.0009) were risk factors for ESBL-PE infection. Easily identifiable factors may help with targeting carbapenem prescriptions.

Aortic dissection and malperfusion syndrome: a when, what and how-to guide.

Malperfusion syndrome is a complication of aortic dissection caused by branch-vessel involvement and resulting in end-organ ischaemic dysfunction. Clinical diagnosis is mandatory, and imaging plays a critical role in confirmation and treatment planning. Radiologists must focus on detecting complications (findings of aortic dilation, rupture, organ ischaemia, etc.) and defining vascular compromise and associated malperfusion mechanisms. All these factors guide the multidisciplinary discussion concerning patient management and the suitability of endovascular treatment. Application of dedicated imaging protocols is mandatory in order to answer clinical and anatomical questions. Endovascular therapy has taken a predominant role in the therapeutic management of malperfusion syndrome with aortic fenestration, peripheral stenting and stent-grafting, all of which are procedures within the domain of expertise of current interventional radiologists. The purpose of this editorial is to present a when, what and how-to guide for all radiologists who encounter complicated aortic dissection.

[The practice of telemedicine by French internal medicine physicians in 2019]. / La pratique de la télémédecine par les médecins internistes français en 2019.

INTRODUCTION: Telemedicine has been developing in France since 2018. The objective of this survey was to assess the knowledge, attitudes, practices and training of internal physicians regarding telemedicine. MATERIAL AND METHODS: A national descriptive observational study carried out between July and October 2019, via an online self-questionnaire with members of the National Society of Internal Medicine and the Association of Young Internists, included a descriptive and comparative analysis by subgroups of age. RESULTS: Analysis of 309 responses from physicians qualified in internal medicine or practicing in an internal medicine service (61,8%) and residents in internal medicine (38%) showed that 34.6% had notions or a good knowledge of regulation of telemedicine. For 62,1%, 72.5% and 74.1% respectively, it could improve patient care, access to care and exchanges between internists and other doctors. The main obstacles to this practice were the absence of face-to-face with the patient (57.3%) and computer dysfunctions (55%). Only 23.3% practiced it, including 88.9% tele-expertise. Telemedicine was performed informally (telephone and email) in 70.8% of the cases. Doctors over the age of 50 were better acquainted with the regulations and more practiced official telemedicine. In total, 54% wanted to practice telemedicine and 72.8% wanted to train there. CONCLUSION: Attitudes towards telemedicine were positive, but few internists knew about it and practiced it formally, warranting appropriate training.

[Cardiac tumors: CT and MR imaging features]. / Tumeurs cardiaques: aspects en scanner et en IRM.

The CT and MR imaging features of the main cardiac tumors will be reviewed. Cross-sectional imaging features may help differentiate between cardiac tumors and pseudotumoral lesions and identify malignant features. Based on clinical features, imaging findings are helpful to further characterize the nature of the lesion. CT and MR imaging can demonstrate the relationship of the tumor with adjacent anatomical structures and are invaluable in the presurgical work-up and postsurgical follow-up.

[Thermal ablation: tolerance and efficacy in a population mostly composed of primary lung cancers]. / Thermo-ablation pulmonaire: tolérance et efficacité thérapeutique dans une population constituée majoritairement de tumeurs primitives pulmonaires.

PURPOSE: Radiofrequency thermal ablation (TA) of lung tumors currently is considered an alternative to surgical management for early primary lung cancers and non-surgical lung metastases. The purpose of this study was to determine the tolerability and efficacy of this treatment in 29 consecutive patients, most of which with primary lung cancers, managed in our center. MATERIALS AND METHODS: Twenty-nine patients with 32 lung tumors less than 35 mm in diameter underwent radiofrequency thermal ablation between May 2004 and July 2008. The CT examinations performed during and after the ablation were reviewed to determine lesion characteristics, complications, treatment, local recurrence rate and survival rate. RESULTS: Sixty-nine percent of our population consisted of primary lung cancer. The incidence of pneumothorax was 72% with 10% requiring drainage. The rate of complete response was 81%. The survival rate at 1 year was 79%. CONCLUSION: Radiofrequency thermal ablation of lung tumors is a minimally invasive technique with high rate of complete response. It can be considered in non-surgical patients with primary or metastatic lung tumors less than 35 mm in diameter.

[State of the art: interventional radiology management of renovascular hypertension]. / Recommandations et bonnes pratiques en radiologie vasculaire interventionnelle: traitement de la maladie réno-vasculaire: sténoses de l'artère rénale (SAR).

The management of renal artery stenosis (RAS) has been the subject of numerous clinical studies and recommendations, most frequently with regards to atherosclerotic RAS. We present the current recommendations from the French Society of Cardiac and Vascular Imaging updated from a recent literature review (April 2008) with regards to medical, endovascular and surgical management of atheroscletotic and non-atherosclerotic RAS. The evidence-based recommendations are ranked by level.

Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study.

OBJECTIVES: Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. METHODS: We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. RESULTS: Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively). CONCLUSION: In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause.

Oxygen-regulated protein-150 prevents calcium homeostasis deregulation and apoptosis induced by oxidized LDL in vascular cells.

Oxidized LDLs (oxLDLs) induce apoptosis, which contributes to the pathogenesis of atherosclerosis. The 150 kDa oxygen-regulated protein (ORP150), an endoplasmic reticulum (ER)-resident chaperone, is upregulated by hypoxia and prevents ischemia-induced cell death. The aim of this work was to investigate whether and how ORP150 can prevent apoptosis induced by oxLDLs in vascular cells. OxLDLs induced ORP150 expression in the ER of human microvascular endothelial cell line (HMEC-1). ORP150 expression was blocked by antioxidants, by the permeant calcium chelator BAPTA-AM, and by inhibitors of the inositol-1,4,5 trisphosphate (IP3) receptors, 2-aminoethyl diphenylborinate (2-APB) and xestospongin C. ORP150 silencing by siRNA-enhanced oxLDL-induced apoptosis, while forced ORP150 expression increased the resistance of cells via an inhibition of the oxLDL-induced calcium rise, and of subsequent calpain activation, cytochrome c release, caspase 3 activation and apoptosis. A similar protective effect was achieved by BAPTA-AM, 2-APB and xestospongin C. Altogether, these data indicate that (i)ORP150 inhibits oxLDL-induced apoptosis by blocking calcium signaling and subsequent apoptosis, (ii)calcium released from ER stores through IP3 channels is involved in the oxLDL-induced calcium rise and apoptosis, and is inhibited by ORP150. Finally, ORP150 is expressed in advanced atherosclerotic lesions, where it may locally participate to reduce the apoptotic effect of oxLDLs and the subsequent risk of plaque rupture.

Aorto-enteric fistula after endovascular abdominal aortic aneurysm repair: case report and review.

OBJECTIVE: To report a case and to review previous publications regarding the rare complication of aorto-enteric fistula following endovascular aortic aneurysm repair. METHODS: We report the case of a stent-graft infection secondary to an aorto-enteric fistula 14 months after uncomplicated endovascular treatment of an infra-renal aortic aneurysm. RESULTS: The surgical treatment involved the removal of the infected graft and in situ aortic replacement by cryopreserved allograft. There have been no major complications noted during the 2-month follow-up after surgery. CONCLUSIONS: An aortojejunal fistula is a possible long-term complication of endovascular treatment of abdominal aortic aneurysm. An explantation of the infected graft and aortic replacement by a cryopreserved allograft is a valuable surgical treatment.

The importance of imaging assessment before endovascular repair of thoracic aorta.

Indications for and experience with placement of endovascular stent grafts in the thoracic aorta are still evolving. Recent advances in imaging technologies have drastically boosted the role of pre-procedural imaging. The accepted diagnostic gold standard, digital subtraction angiography, is now being challenged by the state-of-the-art computed tomography angiography (CTA), magnetic resonance angiography (MRA) and trans-oesophageal echocardiography (TEE). Among these, technological advancements of multidetector computed tomography (MDCT) have propelled it to being the default modality used, optimising the balance between spatial and temporal resolutions and invasiveness. MDCT angiography allows the comprehensive evaluation of thoracic lesions in terms of morphological features and extent, presence of thrombus, relationship with adjacent structures and branches as well as signs of impending or acute rupture, and is routinely used in these settings. In this article, we review the current state-of-the-art radiological imaging for thoracic endovascular aneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. After analysing the technical aspects for optimised imaging protocols for thoracic aortic diseases, we discuss pre-procedural determinants of candidacy, and how to formulate interventional plans based on cross-sectional imaging.

[Cardiac CT: technical considerations]. / Conditions techniques d'utilisation de la tomodensitométrie à rayons X en pathologie cardiaque.

The possibility to perform cardiac and coronary imaging was a major driving force behind an ongoing, rapid evolution of scanner technology, accompanied by improvements of software and post-processing tools. The most recent generations of MDCT with the ability to acquire at least 64 slices simultaneously allow relatively robust morphological and functional imaging of the heart. By nature of its target, the continuously moving heart, cardiac CT is technically more challenging than other CT applications. Also, rapid technical development requires constant adaptation of acquisition protocols. The present manuscript summarizes the current state of technology of cardiac CT. Included are considerations regarding appropriate patient selection, patient medication, contrast enhancement, acquisition and reconstruction parameters, image display and analysis techniques with a special emphasis on radiation dose and all possible measures to keep the dose. It does not constitute a meta-analysis of published literature, but merely reflects an expert consensus on the current technical aspects of cardiac CT imaging.

[Virtual interventional radiology: evaluation of performances as a function of experience]. / Réalité virtuelle en radiologie vasculaire interventionnelle: évaluation des performances de l'opérateur selon son niveau d'expérience.

PURPOSE: To determine the value of an angioplasty simulation to differentiate the users based on their level of experience. To determine the perceived usefulness of an angioplasty simulation program. MATERIALS AND METHODS: Forty-six radiologists performed a renal angioplasty on a VIST simulator (Mentice Corporation, Gothenburg, Sweden); the procedure was completed by 41 radiologists. The radiologists were divided into two groups based on the level of experience. Quantitative variables analyzed included procedure duration time and fluoroscopy time. The radiologists then completed a questionnaire evaluating the simulation program. RESULTS: Radiologists with more than 2 years of clinical experience (n=14) performed the procedures faster (20.4 min vs 27.4 min, p<0.01) using less fluoroscopy time (7.8 min vs 11.2 min, p<0.05) than others. Radiologists performing more than 2 procedures per month (n=14) performed the procedures faster (19.4 min vs 27.9 min, p<0.01) using less fluoroscopy time (7.4 min vs 11.3 min, p<0.05) than other (n=27). The participating radiologists indicated that the simulation was realistic. CONCLUSION: Procedure duration time and duration of fluoroscopy were criteria able to differentiate the users based on their level of experience. The educational value of the simulation program was perceived as helpful by the users.

[Stenting for superior vena cava obstruction associated with lung cancer: monocentric study]. / Mise en place précoce d'une endoprothèse dans les syndromes de la veine cave supérieure: étude monocentrique.

INTRODUCTION: Superior vena cava obstruction is an urgent complication of lung cancer. Superior vena cava stent insertion can be considered to provide rapid relief of the symptoms. METHODS: To estimate the efficiency and the complications of this procedure, we retrospectively analyzed 41 consecutive patients treated during the last 5 years by self-expanding nitinol stent insertion for superior vena cava obstruction due to lung cancer. It was combined with anticoagulation and corticosteroids. RESULTS: 41 patients benefited from this treatment (30 men and 11 women) with an average age of 59 years. Etiologies of the vena cava obstruction were: small cell carcinoma (11), adenocarcinoma (8), squamous cell carcinoma (9), large cell carcinoma (9) and others (4). All patients were symptomatic. The average period between the onset of symptoms and the vascular stenting was 14 days. Specific treatment was chemotherapy (18 patients), radiotherapy (1 patient), or both (14 patients), and no specific treatment for 6 patients. The procedure consisted of the insertion of 1 (73%) or 2 (27%) stents, with an average length and caliber of 7.5 cm and 14 mm respectively. No major complication was reported in short and long-term follow up. Symptomatic improvement was observed for all the patients within 48 hours. Median survival after the stenting was of 6.7 months. CONCLUSION: In our study, vascular stenting for malignant superior cava vena obstruction allows a rapid improvement of the symptoms with very few complications, suggesting a possible role as first line treatment for chemo or radio-resistant tumours.

[Diagnostic vitrectomy in intraocular inflammations: A retrospective series]. / Vitrectomie diagnostique dans les inflammations intraoculaires : étude d'une série rétrospective.

PURPOSE: To determine the diagnostic and functional yield of vitrectomy in patients with uveitis of unknown origin. METHODS: A single-centered retrospective study was performed on patients who underwent a diagnostic vitrectomy for uveitis in the Department of Ophthalmology of the Nancy University Hospital from January 2011 to December 2016. Vitreous samples were analyzed in the cytology laboratory by cytological and immunohistochemical techniques, and in the microbiological laboratory by culture and bacterial, fungal and viral PCR, depending on clinical findings. Preoperative and one- and six-month postoperative visual acuity were collected and compared. RESULTS: Thirty-four patients (39 vitrectomies) were included. Vitreous testing led to a diagnosis in 14 out of 39 cases (36 %): 10 intraocular lymphoma, 2 amyloidosis, 1 CMV retinitis, and 1 choroidal metastasis of cutaneous melanoma with vitreous dissemination. Vitrectomy was negative in 20 patients. Visual acuity improved from 1.2±0.7 logMAR preoperatively to 0.8±0.7 logMAR at 1 month (p<0.001) and 0.9±0.8 logMAR at 6 months (p=0.054). CONCLUSION: In our study, diagnostic vitrectomy and vitreous fluid analysis were useful to diagnose uveitis of unknown origin, most of which were found to be intraocular lymphomas. Visual acuity improved for the majority of patients. Diagnostic vitrectomy with appropriate vitreous analysis related to clinical examination must be considered in the evaluation of uveitis of unknown origin.

[Epidemiologic and etiologic patterns of uveitis in a University Hospital]. / Caractéristiques épidémiologiques et étiologiques des uvéites dans un centre hospitalier universitaire.

INTRODUCTION: The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities. MATERIALS AND METHODS: We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005 and December 31, 2016. Patients under 18 years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded. RESULTS: Six hundred and ninetypatients were included, with 59 % women and a mean age of 49 years. The uveitis was unilateral in 53 % of cases. Panuveitis was the most common form (52 %, N=358), followed by recurrent anterior uveitis (30 %, N=205), posterior uveitis (16 %, N=107), and intermediate uveitis (3 %, N=20). Non-infectious etiologies accounted for 35 % of all uveitis (the most common being HLA-B27 uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13 % (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52 %. A trend toward improvement in diagnostic yield was observed : 53 % of uveitides were considered idiopathic prior to 2011 compared to 50 % after 2011 (P<0,01). CONCLUSION: We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center.