Contemporary management of splanchnic and renal artery aneurysms: results of endovascular compared with open surgery from two European vascular centers.

INTRODUCTION: Splanchnic and renal artery aneurysms (SRAAs) are uncommon but potentially life-threatening in case of rupture. Whether these aneurysms are best treated by open repair or endovascular intervention is unknown. The aim of this retrospective study is to report the results of open and endovascular repairs in two European institutions over a fifteen-year period. We have reviewed the available literature published over the 10 last years. METHODS: All patients with SRAAs diagnosed from 1995 to 2010 in St Marys Hospital (London, UK) and Henri Mondor Hospital (Créteil, France) were reviewed. Preoperative clinical and anatomical data, operative management and outcomes were recorded from the charts and analyzed. RESULTS: 40 patients with 51 SRAAs were identified. There were 21 males and 19 females with a mean age of 57 ± 14.9 years. The aneurysms locations were: 14 (27%) renal, 11 (22%) splenic, 7 (14%) celiac trunk, 7 (14%) superior mesenteric artery, 4 (8%) hepatic, 4 (8%) pancreaticoduodenal arcades, 3 (6%) left gastric and 1 (2%) gastroduodenal. 4 patients presented with a ruptured SRAA. 17 SRAAs in 16 patients were treated by open repair, 15 in 15 patients were treated endoluminally and 17 (mean diameter: 18 mm, range: 8-75 mm) were managed conservatively. One patient with metastatic pulmonary cancer with two mycotic aneurysms of the superior mesenteric artery (75 mm) and celiac trunk (15 mm) was palliated. After endovascular treatment, the immediate technical success rate was 100%. There was no significant difference between open repair and endovascular patients in terms of 30-day post-operative mortality rate and peri-operative complications. No in-hospital death occurred in patients treated electively. Postoperatively, four patients (1 ruptured and 3 elective) suffered non-lethal mild to severe complication in the open repair group, as compared with one in the endovascular group (p = .34). The mean length of stay was significantly higher after open repair as compared with endovascular repair (17 days, range: 8-56 days vs. 4 days, range: 2-6; p < .001). The mean follow-up time was 17.8 months (range: 0-143 months) after open repair, 15.8 months (range: 0-121 months) after endovascular treatment, and 24.8 (range: 3-64 months) for patient being managed conservatively. No late death related to the VAA occurred. In each group, 2 successful reoperations were deemed necessary. In the endovascular group, two patients presented a reperfusion of the aneurysmal sac at 6 and 24 months respectively. CONCLUSION: No significant difference in term of 30-day mortality and post-operative complication rates could be identified between open repair and endovascular treatment in the present series. Endovascular treatment is a safe alternative to open repair but patients are exposed to the risk of aneurysmal reperfusion. This mandates careful long-term imaging follow up in patients treated endoluminally.

History and recent developments in xeroradiography of the breast.

The article deals in very broad terms with the development of xeroradiography. The imaging process is a by-product of the search by Chester Carlson for a method to copy documents. The early experimental work was done at Battelle Memorial Institute, Columbus, Ohio. Clinical trials followed the fabrication of a machine by the Xerox Corporation. The machine as we know it today was introduced to the market in 1970-1971.

Relations of cognitive functions associated with the frontal lobes and learning disorders in children.

Various cognitive processes associated with the frontal lobes and their influence upon learning and learning disorders in children were investigated. Subjects were 29 7- to 12-yr.-old boys and girls. Analysis of variance suggested that, as a group, the learning-disabled children scored lower on tasks with a high demand for selective attention, ability to inhibit interference, sequential reasoning, and integration and organization of new information--cognitive functions commonly attributed to the frontal lobes. The relationship of these cognitive functions to acquisition of basic academic skills is discussed.

Breast parenchymal patterns: prevalent and incident carcinomas.

Breast parenchymal patterns can be divided into four groups: N1, P1, P2 and DY. Although there is evidence that the P2-DY group favors the development of cancer, the risk classification changes when one considers prevalent vs. incident breast cancers. In a purely incident series, a gradual diminution will be seen in the number of N1-P1 cancer cases and a corresponding rise in cancer patients from the P2-DY group.

Risk of developing breast cancer determined by mammography.

1) By breast parenchymal patterns one can isolate women at significantly high and low risk for developing breast carcinoma from the general population. 2) Basically the risk classification does not change with aging. 3) Radiographic screening studies should be concentrated in the high risk groups. 4) The highest risk group, DY, should be considered for aggressive surgical ablation of the tissue capable of generating a breast cancer.

Breast cancer screening. A brief historical review.

Breast cancer screening by a combination of clinical breast examination (CBE) and mammography is effective in reducing mortality from breast cancer in all age groups for years 40 and above. Mammography is the single most effective method in obtaining the mortality reductions. The CBE should not be omitted, however, in that it does add information not apparent on mammography. The CBE can be done safely by a nonphysician properly trained. Breast self-examination (BSE) is ineffectual in reducing mortality. It is debatable if it has a role in screening for breast cancer at all. This observer believes it should be done, in that its cost is minimal once the training is over.

Breast patterns as an index of risk for developing breast cancer.

The radiographic appearance of the breast parenchyma provides a method of predicting who will develop a breast cancer. This paper describes a restrospective study of 7,214 patients. On the basis of the radiographic appearance of the breast parenchyma, patients were placed into one of four groups of risk for developing carcinoma of the breast. Follow-up studies revealed a stepwise progression in the incidence of developing carcinoma of the breast at least 6 months after the radiographic examination. In one of the two substudies, there was a 37 times greater incidence for those at highest risk compared to the low risk group. The classifications presented are thought to be of value in the everyday practice of mammography as well as in planning screening programs.

Developments in mammography.

Mammography is presented for the primarily nonradiologic audience. A brief historical review calls attention to some of the milestones in mammography and how it has changed. Xerororadiography is discussed, as it is one of the newer developments and is rapidly gaining broad acceptance in the United States. Clinical applications are included, with a discussion of the various entities which the radiologist can identify on the mammogram. Although the mammographic examination can be extremely accurate in the hands of interested examiners, some carcinomas will not be identified; of these, some can be discovered by routine physical examination. If mammography is made to stand alone, without a physical examination, some women with breast cancer will not be identified and will not receive prompt, adequate treatment. Mammography is an adjunct and a complement to the physical examination. Breast cancer screening appears to be effective in finding small, nonpalpable tumors, many very early in their growth. Definite evidence is now available that early diagnosis of breast cancer leads to prolonged survival. There is promise of further developments in the field of mammography.

Breast parenchymal patterns and their changes with age.

The appearance of the breast parenchyma was studied in 955 women to determine whether it changed with age. It was found that women initially classified as being at either a low risk or a very high risk of cancer do not demonstrate changes in the breast parenchyma pattern with age. However, breasts in young women which exhibit dysplastic changes on the initial examination (QDY) frequently do change, occasionally to a relatively lower-risk category but often to a normal or near-normal appearance. Such changes generally occur between the ages of 35 and 50.

Risk for breast cancer development determined by mammographic parenchymal pattern.

A classification of risk for developing breast cancer has been devised based solely on the appearance of the breast parenchyma by mammography. Four groups of patients were isolated. The study encompassed a five-year period and was done by reviewing the mammograms of all women over the age of 30 who had been examined at Hutzel Hospital, Detroit. The average time of followup would be approximately 2 1/2 years. Four groups had an incidence of developing breast cancer of 0.1, 0.4, 1.7, and 2.2. These parenchymal patterns are described and criteria for their identification are given.

Correlative studies of the histological and radiographic appearance of the breast parenchyma.

A total of 143 breast biopsies were compared with xeroradiographic images. N1 breasts showed normal stroma, ducts, and lobules; P1 breasts had mild to moderate perioductal and perilobular fibrosis with some atypical lobules and other low-grade lesions; P2 was similar to P1 but with more fibrosis and higher-grade atypical lobules; and DY was generally similar to P2 but with more high-grade atypical lobules and extensive, confluent fibrosis. The highest grades of precancerous epithelial abnormality appear to be found in P2 and DY, seldom in P1, and very rarely in N1. Xeroradiographic and histological risk grades show very close correlation.

Breast pattern classification and observer error.

Using the Wolfe breast pattern classification, a study was conducted to test the reproducibility of this classification in view of its likely significance for breast screening and rescreening programs. The results are highly encouraging, and there was good agreement. Reclassification from low risk occurred in 1% of the cases; reclassification from high risk to low risk occurred in 1.4%. There was a variance of 2.4% in the low-risk group and 0.6% in the high-risk group.