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Vascular complications occurring in Eagle syndrome are seldom described. The aim of this study was to systematically review the occurrence, characteristics, and management outcomes of vascular complications occurring in Eagle syndrome. A systematic review was conducted with a search in several databases. The research question was "What characterizes Eagle syndrome with vascular complications and how should it be managed?" The initial search yielded 4145 results; 150 of these were included, reporting a total of 231 patients with vascular complications. Arterial impingement (67.5%) was more frequent than venous impingement (32.5%). The most frequent consequence of arterial impingement was stroke (46.8%), while for venous impingement it was chronic headache (68%). Seventy-nine patients underwent styloidectomy as initial treatment: 78.5% of the patients were cured and 19.0% improved, while only 2.5% showed a recurrence. On the other hand, among the 106 patients treated medically without initial styloidectomy, only 24.5% of the patients were cured, 28.3% improved, and 47.2% had a recurrence. The association of symptoms of classic Eagle syndrome with neurovascular symptoms should prompt clinicians to consider this diagnosis and to measure the styloid length. Styloidectomy is the treatment of choice to obtain the best cure rate and reduce recurrence. [ABSTRACT FROM AUTHOR]

• A survey of 339 members of the European Association of Cardiothoracic Anaesthesiology and Intensive Care was conducted to gain insights into current European perioperative hypertension management practice. • More than 50% of respondents declared dealing with perioperative hypertension in 20% to 50% of their surgeries, and most (58.7%) target the 120 to 140 mmHg systolic blood pressure range during surgery. • Titratable control was the most appreciated characteristic of an intravenous antihypertensive agent. • The time to goal blood pressure and magnitude and duration of blood pressure excursions are the measures participants mainly consider when assessing the efficacy of antihypertensives. • Antihypertensive treatment failure occurs in less than 20% of surgeries, and the highest risk of hypotensive episodes is perceived by participants to be when using nitroglycerin and nitroprusside. Perioperative blood pressure control is crucial to ensure organ perfusion and avoid adverse events. However, no consensus on blood pressure targets is available. This study was designed to gain insights into current European perioperative hypertension management practices. Survey research. Online survey. The survey was administered to members of the European Association of Cardiothoracic Anaesthesiology and Intensive Care and distributed through the organization's social media. A 22-item questionnaire on the approach to perioperative hypertension control and its pharmacological management. The study included surveys completed between July 1 and October 30, 2023. In total, 339 participants completed the questionnaire; 70% were anesthesiologists, 17% were intensive care physicians, and 12% were cardiac surgeons. More than 50% of respondents declared dealing with perioperative hypertension in 20% to 50% of their surgeries, and most target the 120 to 140 mmHg systolic blood pressure (SBP) range during surgery. Respondents mostly rely on α-adrenoreceptor antagonists (29%), nitrates (23%), and calcium channel blockers (15%) to manage perioperative hypertension. Titratable control was the most appreciated attribute of intravenous antihypertensives. Antihypertensive treatment failure occurred in less than 20% of surgeries, and the highest risk of hypotensive episodes was perceived by participants to be when using nitroglycerin and nitroprusside. Perioperative SBP targets above 140 mmHg are uncommon among respondents, who predominantly target SBP values between 120 and 140 mmHg. The choice of intravenous antihypertensives is based on their manageability and user experience, and titratable control is the most appreciated characteristic. [Display omitted] [ABSTRACT FROM AUTHOR]

Among 1339 unrelated cases accrued by the Italian National Registry for facioscapulohumeral muscular dystrophy (FSHD), we found three unrelated cases who presented signs of Williams-Beuren Syndrome (WBS) in early childhood and later developed FSHD. All three cases carry the molecular defects associated with the two disorders. The rarity of WBS and FSHD, 1 in 7500 and 1 in 20,000 respectively, makes a random association of the two diseases unlikely. These cases open novel and unexpected interpretation of genetic findings. The nonrandom association of both FSHD and WBS points at a gene co-expression network providing hints for the identification of modules and functionally enriched pathways in the two conditions. • Deviations from patterns of Mendelian inheritance have led to the discovery of more complicated genetic bases of disease. • Clinical variations in WBS are controlled by multiple genes. In FSHD reduced penetrance points at complex genetic etiology. • The nonrandom association of molecular defects of WBS and FSHD reveals molecular networks operating in the two diseases. • Genes in both WBS region and FSHD locus provide new hints for understanding the molecular etiology of these diseases. • The systematic collection of detailed phenotypes can shed new light on the complex interactions leading to rare diseases. [ABSTRACT FROM AUTHOR]

Cabozantinib is a second-third line agent for sorafenib-experienced HCC patients. Therefore, it can be prescribed as part of a lenvatinib-sorafenib-cabozantinib or atezo/bev-sorafenib-cabozantinib sequence. Tolerability and safety are key concerns, especially for patients reaching a third-line treatment. However, dose reductions to manage adverse events (AEs) may induce fears of reduced efficacy. Analysis of the MULTICABO cohort (96 patients from 15 Italian centers). We evaluated the relative dose-intensity of cabozantinib during the first 8 weeks (8W-DI; expressed a ratio between the cumulative dose actually received and the maximum theoretical dose). The 8W-DI was correlated with disease control at the first imaging, progression-free survival (PFS), and overall survival (OS). To assess the effects of dose reductions after the first 8 weeks on the OS, multivariable time-dependent Cox regressions were carried out. Disease control rate was 63%. The median PFS and OS were and 5.2 and 11.3 months, respectively. The majority of patients (n=45) received the full 60mg daily dose during the first 8 weeks (median 8W-DI 100%, IQR 70-100%). A 90% 8W-DI (equating to a mean 54 mg/daily dose) was chosen for further analysis. A high 8W-DI did not correlate with worse radiological response (OR 1.72, 95% CI 0.72-4.15), PFS (HR 1.39, 95% CI 0.87-2.22), or OS (HR 1.06, 95% CI 0.61-1.83). Sixty-one (63.5%) and 19 (19.8%) patients permanently reduced cabozantinib to 40 and 20 mg/day to manage AEs. In the time-dependent analyses, reduction to 40 mg and 20 mg were associated with increased OS (HR 0.47, 95% CI 0.29-0.76; HR 0.41 95% CI 0.21-0.80, respectively]. Our results underline the importance of tailored dosing of cabozantinib. Dose adjustements to manage AEs should not automatically induce fears of reduced efficacy, as higher 8W-DI were not related to better outcomes while dose reductions to manage AEs were associated with increased OS. [ABSTRACT FROM AUTHOR]

Introduction The severity of emotional responses to life events (PTSD spectrum) as part of Post Traumatic Stress Disorder (PTSD) in Substance Use Disorder (SUD) patients has often been considered from a unitary perspective. Light has also been shed on the possible definition of a specific psychopathology of SUD patients. This psychopathology has been proved to be independent of treatment choice, of being active in using substances, of lifetime psychiatric comorbidity and primary substance of abuse (heroin, alcohol, cocaine). Methods To further support this unitary perspective, in this study we have compared the severity and typology of the five psychopathological dimensions found in SUD patients, by dividing 93 HUD patients (77.4% males and 22.6% females), characterized by the lifetime absence of exposure to actual or threatened death, serious injury, or sexual violence, on the basis of the severity of their PTSD spectrum. We used the cut-off that differentiated people developing (High PTSD spectrum; H-PTSD/S) or not developing (Low PTSD spectrum; L-PTSD/S) a PTSD after the earthquake that hit L'Aquila, Italy, in April 2009. Results Using a canonical correlation analysis, the significant (p < 0.001) canonical variate set-one (psychopathology) is saturated negatively by “panic anxiety” and positively by the “worthlessness-being trapped” and “violence-suicide” dimensions. Set-two (PTSD spectrum) is saturated negatively by “emotional, physical and cognitive responses to loss and traumas”, and positively by “grief reactions”, “re-experiencing numbing”, “arousal symptoms” and “personality traits”. When comparing the two groups, all five psychopathological dimensions were significantly more severe in H-PTSD/S patients, who were distinguished by higher values of worthlessness-being trapped, sensitivity-psychoticism and violence-suicide symptomatology. No differences were observed regarding the typology of psychopathology. Conclusions This study further supports the SUD-PTSD spectrum unitary perspective and argues in favor of the inclusion of the PTSD spectrum in the psychopathology of SUD. [ABSTRACT FROM AUTHOR]

This study investigates the use of an ORC as heat recovery unit in a natural gas pipeline compression station powered by a gas turbine with the aim of increasing the process energy efficiency. A flexible Matlab ® suite, able to investigate both subcritical and supercritical cycle, has been developed for the plant sizing and for the part-load simulation. The methodology to compute the system energetic performance is discussed. The ORC configuration that guarantees the maximum power output (7.22 MWe) is identified. The yearly electricity yield (42615.9 MWh) reveals good perspectives of implementing ORC with the aim of reducing the environmental impact of gas compression stations. [ABSTRACT FROM AUTHOR]

This study investigates the use of an ORC as heat recovery unit in a natural gas pipeline compression station powered by a gas turbine with the aim of increasing the process energy efficiency. A flexible Matlab® suite, able to investigate both subcritical and supercritical cycle, has been developed for the plant sizing and for the part-load simulation. The methodology to compute the system energetic performance is discussed. The ORC configuration that guarantees the maximum power output (7.22 MWe) is identified. The yearly electricity yield (42615.9 MWh) reveals good perspectives of implementing ORC with the aim of reducing the environmental impact of gas compression stations. [ABSTRACT FROM AUTHOR]

Objective The primary end points of this study were safety and efficacy of early cannulation of the Flixene graft (Maquet-Atrium Medical, Hudson, NH). Secondary end points were complications and patency. Methods This is a prospective single-center nonrandomized study. Study data included patient characteristics; history of vascular access; operative technique; interval between implantation and initial cannulation; complications; and patency at 1 month, 3 months, and every 6 months. Patency rates were estimated by the Kaplan-Meier method. Results Between January 2011 and September 2013, a total of 46 Flixene grafts were implanted in 44 patients (27 men) with a mean age of 63 years. The implantation site was the upper arm in 67% of cases, the forearm in 11%, and the thigh in 22%. Seven grafts were never cannulated during the study period. Of the remaining 39 grafts, 32 (82%) were successfully cannulated within the first week after implantation, including 16 (41%) on the first day. The median interval from implantation to initial cannulation was 2 days (interquartile range, 1-3 days). The median follow-up was 223.5 days (interquartile range, 97-600 days). Five hematomas occurred, but only one required surgical revision. Primary assisted and secondary patency rates were 65% and 86%, respectively, at 6 months and 56% and 86%, respectively, at 1 year. Conclusions This study suggests that cannulation of the Flixene graft within 1 week after implantation is safe and effective. Early cannulation avoids or shortens the need for a temporary catheter. One-year patency rates appeared to be comparable to those achieved with conventional grafts, but long-term follow-up and randomized controlled studies will be needed to confirm this finding. [ABSTRACT FROM AUTHOR]

Objective: We sought to investigate the changes in circulating serum lipids and lipoproteins, including lipoprotein (a), and low-density lipoprotein size in women during normal pregnancy.Study Design: Twenty-two women (mean age, 31 +/- 5 years; 13 primiparous subjects) were studied during uncomplicated pregnancy with normal outcome. Twenty-four nulliparous women of similar age (31 +/- 4 years) were studied as control subjects.Results: Serum triglycerides and total and low-density lipoprotein cholesterol increased significantly during pregnancy in all women. Women with changes in low-density lipoprotein during the second and third trimesters showed a more marked increase in serum triglycerides, and this effect was slightly more evident in the multiparous subjects. No other differences were evident between primiparous and multiparous women apart from high-density lipoprotein cholesterol levels, which were slightly decreased in the latter subjects.Conclusions: Our results show that during normal pregnancy, the increase in plasma triglycerides may lead to the appearance of the atherogenic dense low-density lipoproteins in a subgroup of women. We suggest that the observed changes in low-density lipoprotein patterns during pregnancy might be used to identify those women who later in life will have these atherogenic small and dense low-density lipoproteins. [ABSTRACT FROM AUTHOR]

Aortic stenosis is the most frequent valvular pathology in the developed countries (1). It is most often due to the calcified or degenerated aortic valve as a manifestation of ageing. Sub-valvular aortic stenosis is rare in the adult population being more common in children accounting for 8-20% of left ventricular outflow tract (LVOT) obstructions (2). Stenosis degree may change depending on the malformation varying from a minor ridge to a complete fibrous ring or tunnel. Although proper timing for surgery is unclear, diagnosis might be more difficult in the adult patient with transthoracic echocardiography as subvalvular portions of the LVOT might be shaded by calcium and difficult to visualize. We report a case of a 65 years old lady diagnosed with severe aortic stenosis and scheduled for aortic valve surgery. The patient presented to our department with recent history of shortness of breath and clinical and transthoracic echocardiographic diagnosis os severe aortic stenosis. The maximum blood velocity across the aortic valve was 4.8 m sec-1 at continuous Doppler sampling. She was scheduled for aortic valve replacement. After establishing hemodynamic monitoring, general anaesthesia induction was performed with remifentanil, propofol and cisatracurium and maintained as TIVA. According to our protocol, a transesophageal echocardiography (TEE) was positioned and a baseline TEE was performed. TEE demonstrated a massive concentric hypertrophy of the left ventricle, a membranous subaortic stenosis and a normal aortic valve (fig. 1A,1B,1C). Surgery was then halted as the patient's written consent had been obtained for a valve replacement. Then the patient was further investigated by ECG gated cardiac CT scan, which confirmed the subvalvular membrane. The patient was then operated to remove the subvalvular membrane and a partial septal myectomy was also executed (fig 1D). She completely recovered and was discharged home on p.o. day 5. ▪ Differential diagnosis between aortic valvular stenosis or stenosis due to a subvalvular obstruction might be tricky, but is crucial for the operation result. TEE 2D and 3D imaging recognised the anomaly prior to surgery and so allowed to properly address the cardiac disease leading to post-operative success. Perioperative TEE should be performed in a systematic manner according to the current guidelines (3), but beyond the level of re-confirming the expected findings prior to surgery. TEE allowed for rapid and thorough recognition of previously undiscovered pathology leading to proper patient's management and case resolution, so confirming the importance of perioperative TEE in the setting of surgical treatment of heart valve diseases. [ABSTRACT FROM AUTHOR]

The aim was to study if health outcome and secondary prevention were satisfactory 1 year after stroke and if nurse-led interventions 3 months after stroke could have impact. Design was a randomized controlled open trial in a 1-year population. Primary outcome was health status 1 year after stroke. One month after stroke, survivors were randomized into intervention group (IG) with follow-up by a specialist nurse (SN) after 3 months (n = 232), and control group (CG) with standard care (n = 227), all to be followed up 1 year after stroke. At the first follow-up, patients graded their health, replied to the EuroQol-5 Dimensions (EQ-5D) health outcome questions, health problems were assessed, and supportive counseling was provided in the IG. Health problems requiring medical interventions were primarily referred to a general practitioner (GP). One year after stroke, 391 survivors were followed up. Systolic blood pressure (BP) had decreased in IG (n = 194) from median 140 to 135 ( P = .05), but about half were above the limit 139 in both groups. A larger proportion (22%) had systolic BP >155 in the CG (n = 197) than in the IG (14%; P = .05). In the IG, 62% needed referrals compared with the 75% in the CG ( P = .009). Forty percent in the IG and 52.5% in the CG ( P = .04) reported anxiety/depression. In the IG, 75% and 67% in the CG rated their general health as fairly good or very good ( P = .05). Although nurse-led interventions could have some effect, the results were not optimal. A more powerful strategy could be closer collaboration between the SN and a stroke clinician, before referring to primary care. [ABSTRACT FROM AUTHOR]

Summary: A set of 21 new fluoroquinolones bearing an aromatic or heteroaromatic moiety at C-7 and an alkyl group at N-1 were synthesized based on the lead structure of pirfloxacin and tested in vitro against Mycobacterium tuberculosis (M. tuberculosis) H37Rv by MIC determination in liquid medium. Among the synthesized compounds, 1-(tert-butyl)-6-fluoro-7-(4-hydroxyphenyl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (2o) and 1-(tert-butyl)-6-fluoro-7-(pyridin-3-yl)-4-oxo-1,4-dihydroquinoline-3-carboxylic acid (2n) were found to be the most active ones against M. tuberculosis H37Rv with the same MICs of reference compounds ciprofloxacin (CFX) and levofloxacin (LFX). MICs of 2o and 2n were determined for fluoroquinolone-sensitive and fluoroquinolone-resistant M. tuberculosis clinical isolates and 2o was the most active compound with up 4-fold difference of MIC with respect to CFX. The activity of 2o was also tested at the concentration of 16 μg/mL against M. tuberculosis H37Rv in infected murine macrophages. The results showed a 4-fold decrease in viable count of cell-associated mycobacteria with respect to untreated controls after 48 h of drug incubation. [Copyright &y& Elsevier]

Extracranial carotid aneurysm is a rare vascular manifestation of Behçet disease. To our knowledge, only 32 cases have been reported. This article presents a complex case of a 28-year-old man who was first treated by vein graft reconstruction. At 12 months of follow-up, a nonanastomotic false aneurysm of the vein graft occurred and was treated by interposition of prosthetic graft. Two months later, an anastomotic pseudoaneurysm between the two grafts was excluded by two stent grafts. Based on our experience and a review of the literature, we compared the outcomes of prosthetic and autologous vein reconstructions and discussed the role of carotid ligation and immunosuppressive treatment. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: We report a new salvage technique for treating venous aneurysms (VAs) complicating vascular access arteriovenous fistula (AVF) using externally reinforced venous aneurysmorrhaphy. Design: A retrospective study over a 20-month period from a single centre. Patients: Patients presenting to the vascular surgery department, Bordeaux University Hospital for revision of a vascular access AVF were included. Methods: Reinforced venous aneurysmorraphy consisted in removal of redundant vessel wall followed by reinforcement using an external prosthetic graft. Patency, diameter and flow were assessed by duplex ultrasound at 1, 6 and 12 months after salvage. Results: Thirty-eight eligible patients were identified. Five were excluded because VA was associated with central vein stenosis; the remaining 33 underwent salvage. Indications were rapidly expanding or painful VA in seven cases; VA with frequent bleeding or damaged overlying skin in eight; VA in close relation to a stenosis in two; and VA associated with high-flow rate in 16. Cannulation was attempted after 30 days. Mean follow-up time was 12 S.D. 5 months (range: 4–22). Two repaired AVFs failed. Primary 1-year patency was 93%. No aneurysm or infection occurred. Reduction of high flow was successful in 12 of 16 patients. The remaining four required re-operation. Conclusions: Reinforced venous aneurysmorrhaphy is effective in controlling venous dilation and achieving patency. Reduction of high-flow rates was not always achieved. Further study is needed to evaluate long-term efficacy of this treatment. [Copyright &y& Elsevier]

Purpose: To evaluate the feasibility of endovascular exclusion of popliteal artery aneurysm (PAA) using stent grafts. Methods: The clinical data of all patients who underwent endovascular exclusion of PAA at three French vascular departments between December 1999 and December 2007 were retrospectively analyzed. Outcome measures included graft patency and endoleak. The Kaplan-Meier method was used to calculate the primary and secondary patency curves. Results: A total of 57 PAA in 50 patients (48 men; mean age, 72 ± 11 years; range, 57-96 years) were treated. The type of stent graft used was Hemobahn/Viabahn in 42 (73.7%) cases, Wallgraft in 14 (24.5%) and Passager in one. The mean duration of hospitalization was 5 ± 1.8 days (range, 3-11 days). No patients were lost from follow up (mean, 36 ± 19.4 months; range, 6-96 months). Nine (16%) occlusions and six (10.5%) endoleaks occurred. The global limb salvage rate was 96.5% (55 of 57 PAA). Kaplan-Meier estimates for primary and secondary patency were 85.8% and 87.5% at one year and 82.3% and 87.5% at three years. Conclusions: Endovascular treatment of PAA is feasible in selected patients. The main determinants of success are suitable aneurysm anatomy and dual antiplatelet postoperative therapy. Further studies are warranted to determine long-term outcomes of endovascular repair for PAA. [Copyright &y& Elsevier]

Neuroendocrine tumors (NETs) are rare and malignant neoplasms characterized by their potential to produce metabolically active substances with the capacity to bring about clinical syndromes. The clinical expression of serotonin-producing NETs is known as carcinoid syndrome (CS). The synthesis of serotonin in the brain is dependent on tryptophan availability. At the central level, serotonin is indispensable for mood, anxiety, and sleep regulation. In CS patients, around 60% of all tryptophan is reported to be consumed by tumor cells for the peripheral synthesis of serotonin, increasing the risk of a central deficiency and thus psychiatric disorders. This manuscript reviews the existing literature about psychiatric disorders associated with NETs and addresses the safety of psychiatric drugs in these patients. A systematic search of the biomedical literature was performed using the following databases: PubMed, Embase, CINAHL (EBSCO), PsycInfo (OVID), and Cochrane CENTRAL (Wiley). The database search included articles published between January 1965 and February 2021. Relevant information were charted using a calibrated charting-form. Twenty-two articles were included in the present review. The overall population size of the studies came to 3319 patients. All patients presented a confirmed diagnosis of NET. The information about the presence of CS was confirmed in 351 cases. The psychiatric symptoms reported included mood disturbances (including, depression and anxiety), psychoses, impulse control disorders and sleeping alterations. We also evaluated the presence of cognitive impairments in NET patients. Finally, we summarize the available data regarding the safety of psychiatric drugs in this setting. Psychiatric disorders among NET patients are poorly recognized, and therefore have received very little research attention. As a result, no standardized algorithm is presently available. Our findings support detailed psychiatric evaluation in NET patients, especially in those presenting CS and symptoms suggestive of psychiatric involvement. Not only do cognitive impairment and psychiatry symptoms negatively impact health-related quality of life in cancer patients, they can also reduce survival rates. • A strong rationale supports the potential connection between serotonin brain dysfunction in patients with CS. • In CS patients a peripheric over-consumption of the essential amminoacid tryptophan can cause a serotonin brain dysfunction. • Few prospective studies investigate the epidemiological & clinical features of psychiatric symptoms in NET patients and CS. • An open dialogue between specialists can promote a more comprehensive multidisciplinary approach for a shared decision. • This paper suggests the safety and efficacy of serotoninergic antidepressants in this setting. • More studies are needed to better explore the value of socio-demographic, clinical and pharmacological variables. • Notably, there are possible drug interactions and important potential side effects that should be taken in consideration. • A first comprehensive and detailed insight on this feature, not one of the most common related to NETs, is discussed. [ABSTRACT FROM AUTHOR]

Background & Aims Metformin seems to have anticancer effects. However, it is not clear whether use of glycemia and metformin affect outcomes of patients with advanced pancreatic neuroendocrine tumors (pNETs). We investigated the association between glycemia and progression-free survival (PFS) of patients with pNETs treated with everolimus and/or somatostatin analogues, as well as the association between metformin use and PFS time. Methods We performed a retrospective analysis of 445 patients with advanced pNET treated at 24 medical centers in Italy from 1999 through 2015. Data on levels of glycemia were collected at time of diagnosis of pNET, before treatment initiation, and during treatment with everolimus (with or without somatostatin analogues), octreotide, or lanreotide. Diabetes was defined as prior or current use of glycemia control medication and/or fasting plasma glucose level ≥ 126 mg/dL, hemoglobin A1c ≥ 6.5% (48 mmol/L), or a random sample of plasma glucose ≥ 200 mg/dL (11.1 mmol/L), with reported classic symptoms of hyperglycemia or hyperglycemic crisis. Patients were assigned to groups based on diagnosis of diabetes before or during antitumor therapy. PFS was compared between patients with vs without diabetes. Among patients with diabetes, the association between metformin use and PFS was assessed. We performed sensitivity and landmark analyses to exclude patients who developed diabetes while receiving cancer treatment and to exclude a potential immortal time bias related to metformin intake. Results PFS was significantly longer in patients with diabetes (median, 32.0 months) than without diabetes (median, 15.1 months) (hazard ratio for patients with vs without diabetes, 0.63; 95% confidence interval, 0.50–0.80; P = .0002). PFS of patients treated with metformin was significantly longer (median PFS, 44.2 months) than for patients without diabetes (hazard ratio for survival of patients with diabetes receiving metformin vs without diabetes, 0.45; 95% confidence interval, 0.32–0.62; P < .00001) and longer than for patients with diabetes receiving other treatments (median PFS, 20.8 months; hazard ratio, 0.49; 95% confidence interval, 0.34–0.69; P < .0001). In multivariable analysis, adjusted for other factors associated with outcomes, metformin was associated with longer PFS but level of glycemia was not. Metformin was associated with increased PFS of patients receiving somatostatin analogues and in those receiving everolimus, with or without somatostatin analogues. Sensitivity and landmark analyses produced similar results. Conclusions In a retrospective study of patients with pNETs, we found a significant association between metformin use and longer PFS. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze the pelvic ischemic complications and their impact on quality of life after interventional occlusion of the hypogastric artery (IOHA) in patients undergoing endovascular aortic aneurysm repair (EVAR). Methods: Between January 2004 and April 2012, 638 consecutive patients with aortoiliac aneurysm treated by EVAR were prospectively registered in two teaching hospitals. We identified all EVAR patients who underwent IOHA. Demographic, clinical, and radiologic data were extracted from electronic databases and patient records as requested. All patients who survived the postoperative period took part in a quality of life survey, the Walking Impairment Questionnaire (WIQ), which included four items: pain, distance, walking speed, and stair climbing. Outcome measures included the 30-day rate of pelvic ischemic complications, the buttock claudication (BC) rate at 30 days and during follow-up, and the comparative WIQ scores between patients with persistent BC, those with regressive BC, and those who never had BC after the IOHA procedure. Results: A total of 71 patients (97% men; mean age, 76 years ± 7.69) required 75 IOHA procedures. These were deemed proximal in 44 cases and distal in 31, with use of coil embolization in 64%, Amplatzer plug in 24%, or a combination of coils and plugs in 12%. The technical success rate was 100%. Two patients (2.8%) experienced fatal acute pelvic ischemic complications in the postoperative period after EVAR. Another patient died of iliac rupture during EVAR, leading to an operative mortality rate of 4.3%. Eighteen patients (25.3%) suffered BC, among whom 11 cases resolved at a median follow-up of 42 months. Young age (odds ratio, 0.92; 95% confidence interval, 0.85-0.99; P = .03) and distal IOHA (odds ratio, 3.5; 95% confidence interval, 1.01-11.51; P = .04) were independent predictors of BC occurrence. The actuarial rate of persistent BC was 85% at 18 months. The WIQ scores were lower for patients with persistent BC (median score, 35.04; interquartile range, 16.36; P = .001) compared with patients with regressive BC (median score, 76.5; interquartile range, 36.66; P = .02) or those who never experienced BC after the IOHA procedure (median score, 65.34; interquartile range, 10.94; P < .0003). Conclusions: Pelvic ischemia associated with IOHA may be severe and lead to fatality after EVAR. Our data show that BC may lead to severe quality of life impairment when it does not regress during follow-up. [Copyright &y& Elsevier]

Abstract: Introduction: Type II endoleak with high risks of complications can be managed by endovascular catheterization or direct percutaneous approach if standard endovascular techniques failed as it is reported in our observation. Report: A 79-year-old patient was treated two months earlier by stent-graft for a retroperitoneal rupture of a right common iliac artery aneurysm. The 2 months follow-up CT-scan showed an endoleak from the right hypogastric artery without clearly outflow vessel. Ultrasound guidance was used to access the endoleak, which was then embolized with coils under fluoroscopy. Discussion: This case illustrates the possible advantages of this technique in the treatment of endoleak. [ABSTRACT FROM AUTHOR]