Endovenous laser ablation (980 nm) of the small saphenous vein in a series of 147 limbs with a 3-year follow-up.

AIM: This study aims to demonstrate the treatment outcomes of endovenous laser ablation (EVLA) of incompetent small saphenous veins (SSVs) with a 980-nm diode laser. MATERIALS AND METHODS: Between 1 June 2003 and 30 June 2006, 128 patients (147 limbs) with varicose veins and reflux in the SSV on duplex ultrasound (US) examination were treated with a 980-nm diode laser under US guidance. EVLA was performed using pulsed mode with a power of 10W. The pulse duration (1.5-3 s) was chosen to deliver a linear endovenous energy density (LEED) depending on the SSV diameter measured 1.5 cm below the sapheno-popliteal junction (SPJ) with the patient standing. For SSV diameters between 2 and 4.5mm, the LEED applied was 50 Jcm(-1). The LEED was 70 Jcm(-1) for 4.5-7 mm, 90 Jcm(-1) for 7-10mm. Patients were evaluated at 1-week, 1-month, 1-year, 2-year and 3-year follow-up. RESULTS: The initial technical success rate was 100% in 147 patients. The SSV remained closed in 114 of 117 limbs (97%) after 1 year, all of 61 limbs after 2 years and all of 30 limbs after 3 years. For the three SSVs where re-canalisation was observed, the diameter was greater than 9 mm. Major complications have not been detected and, in particular, there was no deep venous thrombosis (DVT). Ecchymoses were seen in 60% with a median duration of 2 weeks. Temporary paraesthesia (mostly hypoaesthesia) was observed in 40% of treated legs with a median duration of 2 weeks. The maximum duration did not exceed 4 weeks. No skin discolouration, superficial burn, thrombophlebitis or palpable induration was observed. CONCLUSION: EVLA of the incompetent SSV with a 980-nm diode laser appears to be an extremely safe technique. After successful treatment, there is a very low rate of re-canalisation of the SSV. Obliteration of the SSV was confirmed at 1-, 2- and 3-year follow-up; this study suggests that this procedure will provide a lasting result.

[Genetically-driven or supposed genetic-related insulinomas in adults: validation of the surgical strategy proposed by the A.F.C.E./G.E.N.E.M]. / Les insulinomes de l'adulte d'origine génétique supposée. Validation de la stratégie chirurgicale de l'A.F.C.E./G.E.N.E.M. Vers une simplification de l'imagerie pré-opératoire et des dosages per-opératoires.

Between 1971 and 2002, 80 patients underwent surgery for insulinoma at the Department of General and Endocrine Surgery of the Lille University Hospitals. The present report deals with 13 patients with proven multiple endocrine neoplasia type I (MEN I) or supposed genetic-related insulinomas. This entity differs from spontaneous insulinoma by the presence of multiple foci in the pancreas. Enucleation is not advised in this setting due to the strong likelihood of persistence or recurrence. Various studies suggest different strategies for preoperative localization and surgical approach. We analyzed retrospectively the surgical strategy proposed by the A.F.C.E. and G.E.N.E.M. The purpose of this study was to validate the strategy, integrate the contribution of genotypic diagnosis, simplify preoperative imaging studies, and re-evaluate the value of intraoperative baseline secretin-stimulated insulin measurements. We recommend preoperative endoscopic ultrasonography of the pancreatic head only and routine left pancreatectomy with enucleation of cephalic tumors under intraoperative hormone monitoring. Preoperative invasive localization studies are proposed only if the endoscopic ultrasonography is negative for the pancreatic head. Intraoperative secretin stimulation test can be useful in difficult cases, especially with concurrent nesidioblastosis or in case of secondary surgery. All but one of the 13 patients achieved long-term cure with this strategy.