[Radiation-induced carotid stenosis: A personnalized approach]. / Sténose carotidienne post-irradiation cervicale : une approche personnalisée.

INTRODUCTION: Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). METHODS: We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. RESULTS: RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. CONCLUSION: Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

[Computerized tomography false positives in knee medial meniscus injuries. Retrospective study of 400 cases]. / Falsa immagine con Tomografia Computerizzata di lesione del menisco mediale del ginocchio. Studio retrospettivo in 400 casi.

PURPOSE: We retrospectively evaluated the diagnostic reliability of high resolution CT (HRCT) in the study of knee joint conditions. MATERIAL AND METHODS: We reviewed the results of 400 HRCT examinations of the knee performed in 1993 and compared them with arthroscopic findings. The patients were affected with knee pain and the physical findings were insufficient for diagnosis but a sufficient indication for further instrumental tests. CT slices were 1 mm, with .5 mm feed; the images were reconstructed on the coronal and sagittal planes (2 mm thickness and 2 mm gap) with a CT Sytec 3000 unit (GE Systems, Milwaukee, WI, USA). RESULTS: The patients positive for meniscal fracture were submitted to arthroscopy and operated on if positive arthroscopically. We had 164 surgical cases even though the meniscus was damaged in 236 cases. CT was negative in 16 of 164 surgical cases. The meniscal injury was demonstrated with both CT and arthroscopy in 236 cases; there were 8 false positives and 32 questionable cases. In the latter, arthroscopy showed 24 cases of meniscal degeneration and 8 horizontal fractures. Diagnostic accuracy was 96%. CT showed the 8 false positives as radial injuries of the free margin, but in fact they were false images caused by a normal fold which increases in knee valgus. DISCUSSION AND CONCLUSIONS: HRCT is more reliable than conventional CT (diagnostic accuracy: 96% vs 85-90%) and MRI (90% reliable). The use of thin slices also permitted to show that a meniscal tissue interruption on the radial margin is not referrable to fracture, as indicated also in the recent literature, but to a normal fold.

Squamous cell carcinoma arising in a venous ulcer as a complication of the Klippel-Trenaunay syndrome.

Klippel-Trenaunay (KT) syndrome is a vascular malformation characterized by a port-wine stain, varicose veins and hypertrophy of the affected limb. Ulceration is considered an uncommon complication of KT syndrome and occurrence of skin cancer has been previously reported only in one case. We observed a case of KT syndrome in a 48-year-old woman who developed a large ulcer and a squamous cell carcinoma on the affected leg.