[Neurological involvement of sarcoidosis: current diagnostic and therapeutic strategies]. / Atteinte neurologique de la Sarcoïdose : stratégies diagnostiques et thérapeutiques actuelles.

Neurosarcoidosis (NS) is a rare but severe form of sarcoidosis. NS is associated with significant morbidity and mortality. Mortality is about 10% at 10 years with more than 30% of patients who have a significant disability. The most frequent features are cranial neuropathy (the facial and optic nerve most commonly affected), cranial parenchymal lesions, meningitis, spinal corn abnormalities (20-30%) and more rarely peripheral neuropathy (approximately 10-15%). The challenge of diagnosis is to eliminate other diagnoses. Atypical presentations should make to discuss the need for cerebral biopsy in order to highlight the presence of granulomatous lesions while eliminating alternative diagnosis. Therapeutic management is based on corticosteroid therapy and immunomodulators. There are no comparative prospective study to allow us to define the first-line immunosuppressive treatment and the therapeutic strategy in refractory patients. Conventional immunosuppressants such as methotrexate, mycophenolate mofetil and cyclophosphamide are commonly used. Data on the efficacy of anti-TNFα (including infliximab) in refractory and/or severe forms are increasing during the last ten years. Additional data is necessary to assess their interest in first line in patients with severe involvement and a significant risk of relapse.

Advanced multiparametric magnetic resonance imaging of multinodular and vacuolating neuronal tumor.

BACKGROUND AND PURPOSE: Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a rare brain lesion with suggestive imaging features. The aim of our study was to report the largest series of MVNTs so far and to evaluate the utility of advanced multiparametric magnetic resonance (MR) techniques. METHODS: This multicenter retrospective study was approved by our institutional research ethics board. From July 2014 to May 2019, two radiologists read in consensus the MR examinations of patients presenting with a lesion suggestive of an MVNT. They analyzed the lesions' MR characteristics on structural images and advanced multiparametric MR imaging. RESULTS: A total of 64 patients (29 women and 35 men, mean age 44.2 ± 15.1 years) from 25 centers were included. Lesions were all hyperintense on fluid-attenuated inversion recovery and T2-weighted imaging without post-contrast enhancement. The median relative apparent diffusion coefficient on diffusion-weighted imaging was 1.13 [interquartile range (IQR), 0.2]. Perfusion-weighted imaging showed no increase in perfusion, with a relative cerebral blood volume of 1.02 (IQR, 0.05) and a relative cerebral blood flow of 1.01 (IQR, 0.08). MR spectroscopy showed no abnormal peaks. Median follow-up was 2 (IQR, 1.2) years, without any changes in size. CONCLUSIONS: A comprehensive characterization protocol including advanced multiparametric magnetic resonance imaging sequences showed no imaging patterns suggestive of malignancy in MVNTs. It might be useful to better characterize MVNTs.

Multinodular and Vacuolating Posterior Fossa Lesions of Unknown Significance.

Multinodular and vacuolating neuronal tumor of the cerebrum is a rare supratentorial brain tumor described for the first time in 2013. Here, we report 11 cases of infratentorial lesions showing similar striking imaging features consisting of a cluster of low T1-weighted imaging and high T2-FLAIR signal intensity nodules, which we referred to as multinodular and vacuolating posterior fossa lesions of unknown significance. No relationship was found between the location of the lesion and clinical symptoms. A T2-FLAIR hypointense central dot sign was present in images of 9/11 (82%) patients. Cortical involvement was present in 2/11 (18%) of patients. Only 1 nodule of 1 multinodular and vacuolating posterior fossa lesion of unknown significance showed enhancement on postcontrast T1WI. DWI, SWI, MRS, and PWI showed no malignant pattern. Lesions did not change in size or signal during a median follow-up of 3 years, suggesting that multinodular and vacuolating posterior fossa lesions of unknown significance are benign malformative lesions that do not require surgical intervention or removal.

[Local signs of the reperfusion syndrome in obliterating atherosclerosis of the lower extremity arteries and their treatment].

There were examined 32 patients with obliterating atherosclerosis of the lower extremities arteries, in whom the reperfusion syndrome have occurred after performance of the restoration operation. In 8 patients aorto-femoral shunting was performed and in 24--femoro-popliteal one. There was established that local signs of the reperfusion syndrome, as a rule, have occurred in patients with critical ischemia of the lower extremities preoperatively. Characteristic signs of the reperfusion syndrome were noted, the methods of its prophylaxis and treatment were adduced.

[Revascularization of the lower limbs for ischemic diabetic foot with pyonecrotic tissue lesions]. / Revaskuliarizatsii nizhnikh konechnostei pri ishemicheskoi forme diabeticheskoi stopy s gnoino-nekroticheskimi porazheniiami tkanei.

This paper analyzes the results of the treatment of 213 patients with ischemic diabetic foot marked by pyonecrotic tissue lesions. On examination of the patients the authors were governed by the clinical findings as well as by the data supplied by the research methods such as ultrasound Doppler, percutaneous oxymetry, contrast angiography and laser flowmetry. Altogether 89 patients underwent revascularisation of the lower limbs by means of restoring arterial circulation; 72 patients were provided lumbar sympathectomy. The indications were elaborated for use of one or another revascularization technique. It has been established that of the 161 patients provided limb revascularization, the satisfactory results with limb salvage were obtained in 132 (81.9%) patients; high amputations were performed in 22 (13.6%) cases; 7 (4.3%) patients did not improve; after operation no lethal outcomes were recorded. Of the 52 patients who did not undergo lower limb revascularization, the beneficial results were obtained in 37 (71.1%), high amputations were performed in 15 (28.9%) patients. The conclusion is drawn that limb revascularization allows to minimize the number of high amputations more than two fold.

[Restorative operations on main vessels for diabetic angiopathy of lower extremities with purulent-necrotic complications]. / Vosstanovitel'nye operatsii na magistral'nykh sosudakh po povodu diabeticheskoi angiopatii nizhnikh konechnostei s gnoino-nekroticheskimi oslozhneniiami.

There were analyzed the results of treatment of 75 patients with diabetic angiopathy of the lower extremities and purulent-necrotic affection of the foot tissues, to whom restoration operation on the main vessels was accomplished. In 11 patients aorto-femoral bilateral shunting together with lumbar sympathectomy was performed, in 7--femoro-femoral shunting, in 38--femoro-popliteal, in 12--iliofemoral shunting together with lumbar sympathectomy, in 7--thrombendarterectomy from a. femoris communis in conjunction with the vessel dilatation using the patch. In 89.2% of patients satisfactory result with the extremity preservation was noted. In 10.8% of patients high amputation of extremity was done, all the patients are alive.

[Surgical strategies and choice of treatment methods of the sequelae of the main vessels damage in extremities]. / Khirurgicheskaia taktika i vybor sposoba lecheniia posledstvii povrezhdeniia magistral'nykh sosudov konechnostei.

The data on diagnosis, surgical tactics and method of treatment of 75 patients with consequences of the extremities main vessels damage were presented. In 18 patients pulsating hematoma have occurred, in 16--the arterial one, in 12--arteriovenous aneurysm, in 29--the disease of ligated vessel. The data on clinical investigations, ultrasonic dopplerography and roentgencontrast angiography were used for the diagnosis. There were operated on 66 patients. Restorational operation on vessels was done in 47 (71.2%), of them ligation of the vessels--in 16 (24.2%), the lumbar sympathectomy--in 3 (4.5%). The immediate positive result of the treatment was noted in 63 (95.5%) of patients. All the patients are alive. Original method of traumatic aneurysm treatment was adduced.

Coronary stent deployment without predilation in acute myocardial infarction: a feasible, safe, and effective technique.

Direct percutaneous transcatheter revascularization (PTCR) is becoming an acceptable therapy for acute myocardial infarction (AMI). Stenting in the setting of AMI, once considered contraindicated, is emerging as a suitable option in this situation. Coronary stenting without predilation (SWOP) may potentially shorten the procedure and radiation time, reduce costs, and decrease procedural complications such as coronary dissection and distal embolization. It is expected to cause less vascular injury, with a reduction in the rate of in-stent restenosis. In this preliminary study the authors evaluated the feasibility of the SWOP procedure in 22 selected patients with AMI. Indications for catheter-based myocardial reperfusion were the following: extensive anterior wall MI (68%), inferior wall and right ventricular MI (23%), and inferior wall MI with contraindication for thrombolytic therapy (9%). Patients with cardiogenic shock or with contraindications for aspirin or ticlopidine were excluded. SWOP was successful in 21 attempts (95%), and final procedural success was achieved in all. Proximal or distal dissections were seen in three cases and were treated by additional three stents. Thrombolysis in myocardial infarction (TIMI) flow 3 was restored in all patients. There were no distal embolizations, side branch occlusions, coronary perforations, procedure-related emergency bypass operations, or deaths. It is concluded that in selected patients with AMI, coronary artery stenting without predilation is feasible and safe and does not introduce additional risk to the patients.

Coronary stent deployment without predilation: prevention of complications of venous graft angioplasty.

Saphenous vein graft stenting without predilation may potentially decrease procedural complications such as distal embolization and no-reflow phenomenon. In this report the authors describe the deployment of stents (three Wallstents, one Palmaz-Schatz, one Multilink, and one NIR) without predilation in five patients with unstable angina pectoris due to high-grade stenosis in old saphenous vein grafts. Stent deployment was successful in all patients without procedure-related complications. Stenting without predilation appears to be feasible in old bypass grafts with significant stenosis. The potential of this new stenting technique to reduce the risk of stenting complications should be tested by a randomized trial.

[Surgical treatment of recurrences of varicose veins of the lower extremities]. / Khirurgicheskoe lechenie retsidivov varikoznogo rasshireniia ven nizhnikh konechnostei.

Operations for recurrent varicosities were made in 48 patients. Extravasal correction of the femoral vein valves, dissection of the popliteal vein aneurysms and ligation of the communicatory veins were also performed in addition to the extirpation of dilated subcutaneous veins.

[Technic for restorative operations in injury to the proximal portion of the femoral vein]. / Tekhnika vosstanovitel'nykh operatsii pri povrezhdenii proksimal'nogo otdela bedrennoi veny.

Some problems of surgical treatment of wounds of the proximal portions of the femoral vein are discussed. Considering the development of chronic venous insufficiency, resulting from the ligation of the vein at this level, the necessity of a timely restoration of the main blood flow in such vascular injuries is noted.