Identification of the Factors Associated With Intraperitoneal Pressure in ADPKD Patients Treated With Peritoneal Dialysis.

INTRODUCTION: Peritoneal dialysis (PD) is reported to be underused in the autosomal dominant polycystic kidney disease (ADPKD) population because doctors fear technical failure caused by reduced abdominal space and high intraperitoneal pressure (IPP). METHODS: We designed a multicenter retrospective study to be carried out in 15 French centers recruiting 60 patients with ADPKD treated with PD to identify factors associated with IPP. Inclusion criteria were start of PD between 2010 and 2017, available tomodensitometry, and IPP measurement in the first year of dialysis. The clinical and radiological data for each patient were reviewed by the same operator. Total kidney volume (TKV), liver volume, and the volume of the abdominal cavity were measured using contouring. RESULTS: TKV and the volume of the abdominal cavity in women and men were, respectively, 2397 ml versus 3758 ml and 9402 ml versus 12,920 ml. In the univariate analysis, IPP was significantly and positively associated with body surface area (P = 0.0024), body mass index (BMI) (P < 0.0001), the volume of the abdominal cavity (P = 0.0005), and the volume of the dialysate infused in the peritoneal cavity (IPV) (P = 0.0108). In the multivariate analysis, only BMI was still significantly associated with IPP (P = 0.0004). CONCLUSIONS: Our results identified BMI as the main factor linked to IPP in patients with ADPKD. Despite a reliable assessment of the volume of their organs we did not find any correlation between liver and kidney volumes and IPP. To our knowledge, this is the first study designed to identify factors associated with IPP in patients with ADPKD on PD.

Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan.

Impact of Obesity on Overall Radiation Exposure for Patients Who Underwent Radiofrequency Ablation of Atrial Fibrillation.

Patients who underwent radiofrequency ablation of atrial fibrillation are exposed to X-rays not only during the procedure but also during the preprocedural computed tomography. No study has investigated the cumulative effective dose received by patients who underwent atrial fibrillation ablation and identified factors influencing this dose. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent radiofrequency ablation of atrial fibrillation. The secondary objective was to estimate the impact of obesity on this exposure. All patients who underwent a first attempt of radiofrequency ablation of atrial fibrillation in our center over a 21 months period were included. Dosimetric indicators from preprocedural computed tomography and the ablation procedure were collected and converted into an effective dose. A total of 144 radiofrequency ablation of atrial fibrillation were included. The mean cumulative effective dose was 11.4 mSv, and 82% of the dose was from the computed tomography. Obese patients received a dose that was 75% higher than normal-weight patients, and this increase remained significant by multivariate analysis. In conclusion, overall exposure to ionizing radiation for patients who underwent radiofrequency ablation of atrial fibrillation seems acceptable, and the majority of the overall effective dose comes from the computed tomography. Obese patients are exposed to a 75% higher dose than normal-weight patients.

Maximum Diameter of Native Abdominal Aortic Aneurysm Measured by Angio-Computed Tomography: Reproducibility and Lack of Consensus Impacts on Clinical Decisions.

BACKGROUND: Computed tomography angiography (CTA) is the reference technique for the measurement of native maximum abdominal aortic aneurysm (AAA) diameter when surgery is being considered. However, there is a wide choice available for the methodology of maximum AAA diameter measurement on CTA, and to date, no consensus has been reached on which method is best. We analyzed clinical decisions based on these various measures of native maximum AAA diameter with CTA, then analyzed their reproducibility and identified the method of measurement yielding the highest agreement in terms of patient management. MATERIALS AND METHODS: Three sets of measures in 46 native AAA were obtained, double-blind by three radiologists (J, S, V) on orthogonal planes, curved multiplanar reconstructions, and semi-automated-software, based on the AAA-lumen centerline. From each set, the clinical decision was recorded as follows: "Follow-up" (if all diameters <50 mm), "ambiguous" (if at least one diameter <50 mm AND at least one ≥50 mm) or "Surgery " (if all diameters ≥50 mm). Intra- and interobserver agreements in clinical decisions were compared using the weighted Kappa coefficient. RESULTS: Clinical decisions varied according to the measurement sets used by each observer, and according to intra and interobserver (lecture#1) reproducibility. Based on the first reading of each observer, the number of AAA proposed for surgery ranged from 11 to 24 for J, 5 to 20 for S, and 15 to 23 for V. The rate of AAAs classified as "ambiguous" varied from 11% (5/46) to 37% (17/46). The semi-automated method yielded very good intraand interobserver agreements in clinical decisions in all comparisons (Kappa range 0.83-1.00). CONCLUSION: The semi-automated method seems to be appropriate for native AAA maximum diameter measurement on CTA. In the absence of AAA outer-wallbased software more robust for complex AAA, clinical decisions might best be made with diameter values obtained using this technique.

A case report of male breast cancer in a very young patient: what is changing?

Male breast cancer accounts for 1% of all breast cancer cases, and men tend to be diagnosed at an older age than women (mean age is about 67 years). Several risk factors have been identified, such as genetic and hormonal abnormalities. The present study reported the case of a 25-year-old man who was diagnosed with an advanced invasive ductal carcinoma; however, he did not have any important risk factors. Even though more data is emerging about this disease, more efforts to understand risk factors, treatment options and survival benefits are needed. In this case, we discussed the risk factors as well as the impaired fertility associated with breast cancer therapies.