Search

The purpose of this study is to determine whether pharmacogenetic testing could be used to effectively customize postoperative pain medicine following total joint replacement.Buccal swabs were collected preoperatively from 107 patients. Pharmacogenetic testing was performed for genetic variants on a panel of 16 genes, including CYP2D6, CYP2C9, OPRM1, and CYP1A2, which affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and many opioids. Patients were randomized to a control group or custom group and blinded to their group. The control group was prescribed oxycodone, tramadol, and celecoxib for postoperative pain management. If any of those were not normally metabolized, they were not prescribed to the patients in the custom group, who were given an alternative drug (hydromorphone for narcotics, meloxicam for non-steroidal anti-inflammatory drugs). Patients recorded their pain level (0-10 numeric scale) and all medications taken daily for the first 10 days following surgery. Medication was converted to milligram morphine equivalents (MMEs).Genetic variations to medications in our standard postoperative pain management protocol occurred in 24 of the 107 patients (22.4%). The 10-day MME consumed by patients in the control group with genetic variants was 162.6 mg. Patients with variants who had custom postoperative medication consumed only 86.7 MME in the same timeframe (P = .126). The control group demonstrated a higher 10-day average pain level of 4.2 vs the custom group pain level of only 3.1 (P.05).With custom postoperative pain prescriptions based on pharmacogenetic testing, patients were able to achieve lower pain levels while reducing the consumption of pain medication.

Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to total hip arthroplasty (THA). This study aims to compare acute postoperative narcotic consumption between the 2 procedures and quantify amount of narcotics used by opioid prescribed.From October 2017 to August 2019, patients were surveyed at 4-week follow-up to determine amount and duration of opioids used and whether they continued to require narcotics. Among 1332 patients who self-identified as opioid naïve, 670 underwent THA and 662 underwent TKA. Descriptive analysis was performed based on data type.The total morphine equivalent dose (MED) used in the postoperative period was lower in THA than in TKA (143 ± 160 vs 259 ± 250 MED, P.001). The duration of use was shorter, total amount of pills consumed was lower, and refill rates were less in THA compared to TKA regardless of which opioid was prescribed. A smaller proportion of patients required narcotics at 4-week follow-up in THA compared to TKA. A postoperative prescription of 45 pills of any one type of narcotic was sufficient for nearly 90% of THA patients, and 60 pills of any one type of narcotic was appropriate for over 75% of TKA patients.THA is associated with less total narcotic consumption, shorter duration of use, less refills, and lower likelihood of requiring narcotics at 4-week follow-up. Percentiles of total narcotics consumed are provided to promote judicious postoperative prescribing patterns, and one could consider further reducing narcotics when utilizing our protocol, particularly for THA patients.This is a level III retrospective cohort study reviewing narcotic use in over 900 consecutive opioid-naïve patients undergoing total hip and knee arthroplasty.

Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to unicompartmental knee arthroplasty (UKA). The purpose of the current study is to compare acute postoperative narcotic consumption between the 2 procedures and quantify narcotic consumption.From October 2017 to August 2019 patients were surveyed for four weeks to determine the amount and duration of opioids consumed and requirement for continued narcotics. Among 976 opioid naïve patients, 314 (32%) underwent UKA and 662 (68%) underwent TKA. Patients were analyzed according to specific narcotic prescribed. Total morphine equivalent dose (MED), number of pills, duration, refill percentage, and usage percentage for 4 weeks were calculated for each procedure.MED used in the postoperative period was lower in patients undergoing UKA than TKA (200 ± 195 vs 259 ± 250 MED, P = .002). Total number of pills consumed and duration of use was less in UKA compared to TKA regardless of which opioid was prescribed. A smaller proportion of patients required narcotics for 4 weeks after UKA (32% vs 43%, P.001), and fewer UKA patients required narcotic refills (14% vs 27%, P.001). Sixty pills of any 1 type of narcotic was sufficient for 90% of UKA patients and over 75% of TKA patients.UKA is associated with less narcotic consumption, shorter duration of use, less refills, and lower likelihood of narcotic requirement for 4 weeks. We report narcotic consumption patterns for both procedures to aid surgeons in judicious postoperative prescribing.This is a level III retrospective cohort study reviewing narcotic use in over 900 consecutive opioid naïve patients undergoing UKA or TKA.

Purpose Electrochemotherapy (ECT) is a therapeutic approach based on the local application of electrical pulses that permeabilize cell membranes to enhance the uptake of low-permeant chemotherapeutic agents, thus increasing their cytotoxic effects. Materials and methods Twenty-one patients with SCC of the lower lip were treated according to the European Standard Operating Procedures of Electrochemotherapy. Bleomycin (15,000 IU/m2 body surface area) was administered intravenously over a 1-min period. Eight electrical pulses (amplitude, 1000 V/cm; duration, 100 μs) were generated and delivered at a repetition frequency of 5 kHz. Changes in tumor volume were used to assess treatment response. Results Objective response (OR), complete response (CR), and partial response (PR) rates of 100%, 71.4%, and 28.6% respectively were demonstrated following a single session of ECT. ECT was well tolerated, and no adverse events occurred. Conclusions Intravenous bleomycin-based ECT is a safe and effective therapy for SCC of the lower lip. ECT improves the quality-of-life of patients by preserving the function and the aesthetic appearance of the affected area. ECT provides a therapeutic option for elderly and frail patients who, due to their state of health, are not suitable for, or refuse surgical interventions.

Introduction Hereditary heart diseases are most often characterized by autosomal dominant inheritance and delayed cardiac expression. Predictive genetic testing (PGT) is offered to asymptomatic relatives to allow targeted medical care with early therapeutics in order to reduce the risk of complications. Purpose The aim of this study was to evaluate the psychological and socio-professional impact of predictive genetic testing in hereditary heart diseases through a prospective and retrospective study. Methods & results This multicentric French study involved 20 expert centers in hereditary heart diseases. We included 517 adult relatives (42.3 ± 16.7 years, 60.6% females) who performed PGT (prospective study: n = 264, retrospective study: n = 253). The opinion and experience were collected via auto-questionnaires, at various moments in the prospective study, with different items and validated scales (STAI and IES). In the prospective study, family history was characterized by cardiomyopathy (88.4%) and channelopathies (11.6%). The main motivations for performing the test were: “to remove doubt” (65.3%), “for children” (64.0%), “to benefit from medical supervision” (34.9%). A mutation was present in 39.4% of relatives. No regret was expressed after testing (only 2.3% regrets). The result did not lead to a socio-professional change or family relationship change in 60.7%. Among those who had a change, it was perceived as unfavorable for only 3%. The level of anxiety (STAI) increases before the test result and decreased to return to baseline. Subjects with depression history were more likely to develop anxiety at long-term after multivariate analyses (P = 0.004). Conclusions Our results show that contrary to a widespread opinion, the medical benefit was not the main motivation for predictive genetic testing. In most cases, no or marginal adverse psychological and socio-professional impact of genetic testing was observed when performed by a team expert in predictive testing.

Introduction Hereditary heart diseases (cardiomyopathy & channelopathies) are most often characterized by autosomal dominant inheritance and delayed cardiac expression. The risk of complications of these diseases are sudden cardiac death and heart failure. Medical management allow to reduce significantly, but does not cancel, the risk of complications. If the causal mutation is known, couples with a pregnancy project may discuss the use of prenatal genetic diagnosis (PND) or preimplantation genetic diagnosis (PGD). The use of PND or PGD in these diseases is controversial and the medical, ethical and psychological issues are particularly complex. Purpose The aim of this study was (i) to collect at national level the procedures of PNDs and PGDs in the context of “isolated” hereditary heart disease; (ii) obtain the opinion of patients about this issue. Methods and Results The data collected with help of the French Biomedicine Agency show that 18 PND were carried out in France between 2009 and 2017 and 13 PGD between 2013 and 2017. So, number of PND and PGD for hereditary heart disease is rare in comparison of the relatively high prevalence of these diseases. The opinion of 20 patients (95% with cardiomyopathy), followed at Pitie-Salpetriere referral center for hereditary heart diseases, was prospectively collected via auto-questionnaires. Their answers show that few know the options (PND, PGD, gamete donation, adoption): only 25% are aware of all the alternatives. Despite this, 45% of patients mentioned that they did not want more information about these procreation options. Moreover, 45% consider the use of a PND to be fully acceptable or acceptable and 75% for the use of PGD, although they would not ask for themselves. Conclusions We report the first data about procreation procedures in France, and wishes of patients, in non-syndromic hereditary heart diseases. This may help to better manage these complex issues in clinical practice.

Basic cytogenetic knowledge and genome size data on marine phanerogams are essentially limited, although they are indispensable to plan correct experimental designs and for the right interpretation of genetic data, particularly those requiring detailed analyses of genome structure and evolution. Observations on mitotic divisions and chromosomal behaviours as well as DNA measurements have been carried out on five Cymodocea nodosa populations from Sicilian coasts. Standard chromosome counting and Image Cytometric analyses were used to determine the chromosome number and the ploidy of each population. High chromosome number variation was detected in individuals from all the studied populations, even in a single root (aneusomaty). The numbers varied according to the cell position. Near the apical meristem, it was lower, while far from the apex the majority of dividing cells showed higher chromosome numbers. Mitotic anomalies were also detected. The relative DNA value of nuclei confirmed that all of the studied populations presented polysomaty. Cytological and cytometric data clearly indicated that the combined action of endopolyploidy and mitotic anomalies were involved in this uncommon cytogenetic behavior. The data reported represent the first contribution to understanding the basic cytogenetics in this genus.

Resume Dans la dystrophie myotonique de Steinert, la litterature montre l’importance de la plainte de fatigue, sa specificite, mais aussi les limites des modeles utilises a ce jour. Objectif Affiner la comprehension du symptome de fatigue subjective. Methode Analyser la fatigue dans d’autres affections medicales, dans lesquelles la fatigue a ete etudiee. Resultats La fatigue subjective, dans une prochaine etude, sera etudiee comme l’equation de trois differents sous-types de fatigue. Une fatigue « centrale », qui serait en lien avec des dysfonctionnements du systeme nerveux central et avec des alterations cognitives. Une fatigue que nous appelons « adaptative », qui serait la consequence des efforts mentaux et physiques necessaires pour compenser le handicap et l’alteration fonctionnelle, selon les ressources psychologiques individuelles. Enfin, une fatigue appelee « secondaire », qui serait en lien avec les troubles psychologiques (depression et/ou anxiete).

Resume Partant de leurs experiences cliniques et de l’etat actuel des connaissances internationales, les auteurs ont choisi de decrire l’evolution des connaissances psychologiques, neuropsychologiques et des pratiques cliniques dans quatre domaines : consultations pluridisciplinaires et reseaux de soins, annonce de la maladie a l’enfant, apports des connaissances en neuropsychologie a la comprehension des troubles des personnes atteintes de dystrophie myotonique, interets et limites des etudes qualite de vie.

Resume Depuis leur apparition en pratique clinique, une attention particuliere a ete portee aux tests genetiques, notamment en ce qui concerne l’information concernant le test et ses resultats, la confidentialite, le consentement du demandeur et les impacts psychologiques. Un test presymptomatique est possible et peut etre propose dans le cas ou une anomalie genetique causale a ete identifiee chez un membre de la famille, en respectant les principes d’autonomie, de confidentialite et de respect du droit de ne pas savoir. Une attention particuliere est necessaire quand le sujet a risque est un enfant asymptomatique pour qui certains de ces principes peuvent etre remis en cause, surtout lorsque le benefice medical n’est pas clair. Nous rapportons ici les resultats d’une enquete realisee en France a partir des reponses de 50 geneticiens interroges sur leurs positions et pratiques par rapport aux tests genetiques presymptomatiques chez les mineurs, ainsi que les positions sur le sujet du groupe francais de genetique predictive. La reflexion a ete menee sur 3 groupes de maladies : celles pour lesquelles il existe un benefice medical potentiel pendant l’enfance (exemple : retinoblastome) ; celles debutant pendant l’enfance pour lesquelles il n’existe pas de benefice medical immediat (exemple : amyotrophie spinale infantile de type II/III) et celles debutant a l’âge adulte pour lesquelles il n’existe pas de benefice medical pendant l’enfance (exemple : maladie de Huntington). Apres debat, quelques recommandations de bonnes pratiques ont ete enoncees : aucun test genetique presymptomatique ne devra etre realise chez un mineur sans l’en informer s’il a acquis une maturite suffisante pour le comprendre ; les demandes concernant un test genetique presymptomatique pour une pathologie a revelation a l’âge adulte devront etre differees ; toutes les demandes doivent etre referees a une equipe pluridisciplinaire declaree pour la prise en charge des tests genetiques presymptomatiques.

The reproductive phenology of Gracilaria gracilis has been followed closely in a brackish water lake in Sicily. The life history of this red alga deviated from the typical Polysiphonia-type cycle and was characterized by the predominance of the tetrasporophytic phase over gametophytes, in situ development of germinated gametophytes and the presence of sterile pleustophytic thalli. Release of spherical agglomerates of cells produced by young tetrasporophytes was observed as well. Their ability to germinate forming new thalli appears to represent an alternative reproductive strategy of this organism. The population structure appears to reflect a predominance of the diploid phase except during the warmer summer season when only vegetative juveniles were found in the lake. Release and early stages of development of carpospores and tetraspores were critically observed in culture. A Dumontia type pattern of germination was observed for both types of spores, showing an erect thallus arising from a multicellular basal disk. Compared to tetraspores, carpospores are less readily released resulting in a subsequent delay in the development of new gametophytes.

This study investigated reading and spelling difficulties in subjects with the juvenile form of myotonic dystrophy (MD). Twenty-three consecutive patients with juvenile MD who were referred to a special clinic were assessed for reading and spelling skills (phonological processing, word identification, narrative comprehension (two tasks), information seeking in a document (TV schedule), and spelling). Reading impairments were frequent (63–84% of the subjects being below the level of literacy depending on the tasks), even in subjects without mental retardation (22–66%) despite normal word identification scores. All but two subjects had spelling difficulties. The severity of these learning difficulties was correlated with longer mutation size and maternal transmission, but could not be related to phonological deficit, suggesting that other brain dysfunction might be involved (e.g., attention, working memory, naming speed, executive function). Children

Objectif Analyser une revue de la litterature de patients de moins de 20 ans atteints d’un carcinome epidermoide de la cavite buccale et de la langue, en y associant nos 2 cas. Patients et methodes Nos patients ont ete recherches sur le logiciel Medlog et les autres cas l’ont ete dans la litterature de langue francaise et anglaise sur Medline. Resultats Entre 1981 et 2000, 16 patients ont ete retenus. Leur âge moyen etait de 15,6 ans. Le sex-ratio homme/femme a ete de 2,2. Le delai moyen de diagnostic a ete de 16,4 mois dont 71,4 % de tumeurs classees stade III ou IV au moment du diagnostic. Avec un suivi moyen de 33,2 mois, 50 % des patients n’ont jamais ete controles et 1 patient a presente une recidive. A la fin de l’etude, 7 (43 %) patients etaient vivants dont 1 en recidive. Tous les deces etaient lies au cancer dont 7 sur 8 pour des tumeurs de stade III ou IV. Discussion Le faible effectif sur une tres longue periode de recherche confirme le caractere exceptionnel du carcinome epidermoide de la cavite buccale en dessous de 20 ans. Le long delai moyen de diagnostic est tres probablement un facteur de mauvais pronostic, expliquant le stade souvent avance de diagnostic et l’importance du taux de non controle. Toute lesion de la cavite buccale doit beneficier d’un examen histologique quel que soit l’âge.

II n'y a pas dans la litterature d'etude systematique de la participation a la reeducation dans les maladies neuromusculaires. Les facteurs socio-economiques, motivationnels et le renforcement positif ne permettent qu'une comprehension partielle des mecanismes en jeu. D'autres facteurs interviennent : alliance therapeutique et engagement lors de la prescription, systeme de croyances et poids de l'information, importance des theories profanes, representation et mecanisme de defense vis-a-vis d'une non-acceptation consciente ou inconsciente de la maladie. Les avis d'experts font apparaitre l'importance d'un espace de parole libre pour le patient, d'un pacte therapeutique sur des objectifs cibles.

Shotgun injuries to the maxillofacial region may have minor or, more often, devastating consequences. The most important factor in determining the extent of injury is the distance of the victim from the muzzle of the gun: usually, the longer the distance, the less severe the damage. Here is reported a case of shotgun injury sustained from a distance of approximately 10 m in which the deeper penetration of a single lead pellet led to significant involvement of the temporomandibular joint.

The permeation of nicotine through human epidermis in vitro, membranes, adhesives, an adhesive-membrane laminate, and the laminate with epidermis was measured. Skin irritation in rabbits was shown to depend on the driving force of nicotine in the donor phase. A transdermal nicotine system is described that provides substantial control of nicotine entry through skin by a rate-controlling membrane.

Donor site complications of the radial forearm are a significant cause of post-operative morbidity. 15 patients had radial forearm free tissue donor sites treated with split skin grafts and a negative pressure dressing. All grafts showed 100% take at 5 days. The advantages of this technique include rapid healing at an unfavourable graft recipient site, increased graft take and decreased donor site complications. This method is ideally suited for the management of large defects. The dressing can be quickly and easily applied and there have been no significant complications.

Hereditary heart diseases are typically characterized by autosomal dominant inheritance and delayed cardiac expression. Predictive genetic testing is offered to asymptomatic relatives to allow targeted medical care with early therapeutics in order to reduce the risk of complications (sudden death, heart failure). Psychological and sociological issues related to predictive testing are however complex and have been poorly studied. Predictive genetic testing is performed in our multidisciplinary out-patient clinic dedicated to cardiogenetics since 1999. To evaluate our practices regarding predictive genetic testing for hereditary heart diseases and study the behavior of relatives after pre-test consultation (information phase), especially regarding a waiting period that was offered before blood sampling. We retrospectively studied records from 304 consecutive relatives seen in our department and have requested predictive genetic testing. Underlying diseases in the families were HCM (60%), DCM (17%), ARVC (15%), LQT (5%), Brugada syndrome (2%) and other (1%). A total of 21 different genes were analyzed and most frequent ones were MYBPC3 (97), MYH7 (77), LMNA (37), PKP2 (29) and TNNT2 (16). There were 260 adults and 44 minors. At the time of the first consultation, the average age was 37 years, and 83% of the relatives previously had a cardiac checkup (echocardiography for 71%). After first multidisciplinary consultation, 22 relatives (8%) dropped out of procedure (did not performed blood sampling) and 11 relatives (3%) performed blood sampling but did not come back to know their results. Blood sample was delayed for 70% of relatives and immediate for 30%. A mutation was present in 36% of relatives (leading to careful follow-up and cascade screening in offspring) and absent in 64% (they were reassured and discharged from clinic). We observed a high level of genetic uptake after initial consultation but a minority of relatives decided to stop or delay the procedure. These results suggest the benefit of a waiting period before blood sampling and illustrate the importance of a multidisciplinary team in this setting.

From 1963 to 1975, 479 pregnant diabetic women and 484 newborn infants were treated. Insulin was administered to a MTD in both patients with clinical and those with latent diabetes. The control of maternal diabetes is "as strict as possible" and can be guaranteed "a priori" in every case. The total and corrected perinatal death rates in our study were, respectively, 2.9% and 1.9%. The birth weights were similar to those of neonates of nondiabetic mothers (neonates weighing more than 4,000 grams, 3.4%). Serious malformations were reduced to 2.4%. Labor began spontaneously in 90% of cases and cesarean section was performed in 24.6% of cases (a quarter of them in multiparas who had undergone cesarean section in previous pregnancies). The results show that the perinatal risk in pregnant diabetic women can be reduced to a level comparable to that in nondiabetic pregnant women. Excellent control of maternal diabetes throughout pregnancy is confirmed to be essential for the best fetal prognosis. The adopted criterion of insulin administration seems to fulfill this requirement. It can be also applied to pregnant women with latent diabetes, in whom insulin therapy can reduce fetal risk.

OBJECTIVE: The objective of this study was to evaluate early and late results of the Anaconda aortic endograft (Vascutek, Terumo, Inchinnan, Scotland) in a single-center experience. METHODS: From September 2005 to March 2012, patients underwent endovascular aortic repair for abdominal aortic aneurysm (AAA) with Anaconda endograft were prospectively enrolled in a dedicated database. Demographic and aortoiliac morphological data were considered. Preoperative planning was based on thoracoabdominal and pelvic computed tomography angiography. Follow-up included duplex ultrasound or computed tomography angiography at 1, 6, and 12 months and yearly thereafter. Primary end points were technical success, early and late primary and primary assisted clinical success (CS), overall and AAA-related survival and freedom from reinterventions. Secondary end points were endoleaks (ELs), steno-obstructive iliac leg complications, and AAA shrinkage. RESULTS: An Anaconda endograft was implanted in 177 patients (male 94%; mean age, 73.3 ± 7.4 years; American Society of Anesthesiologists class III-IV, 85% and 9%, respectively). The mean AAA diameter, neck length, and diameter were 55 ± 9.7 mm, 26.7 ± 10 mm, and 23 ± 2.3 mm, respectively. There was an aortic neck angle >60° in 44 (25%) patients. Iliac angles >90° were observed in 152 (43%) iliac axes. Technical success was 98.9%. Early CS was 96%. Mean follow-up was 33 ± 23.3 months. Late assisted CS was 97.7%. Survival at 12, 24, and 36 months was 96.4%, 89%, and 86.2%, respectively. There was only one case of late AAA-related mortality. Freedom from reintervention was 94%, 92%, and 85% at 12, 24, and 36 months, respectively. Three (1.7%) conversions occurred during follow-up. There were 14.1% ELs at the completion angiography (EL Ia, 1.1%; EL II, 13%). Late ELs were 20.2% (EL Ia, 1.1%; EL Ib, 2.2%; EL II, 16.9%). Iliac leg complications occurred in 5.6% of the cases. An AAA shrinkage >5 mm was observed in 130 (73.4%) patients. In 7 (4%) cases there was an AAA enlargement >5 mm. CONCLUSIONS: Data in our series demonstrate that the Anaconda endograft has good early and late results in the treatment of AAAs.

Objective/background The influence of contralateral carotid occlusion (CCO) on the outcome of carotid endarterectomy (CEA) and stenting (CAS) is debated. This study aims to evaluate CEA and CAS results in patients with CCO. Methods All carotid revascularizations from 2005 to 2011 were analyzed, focusing on the role of CCO on 30-day cerebral events and death (CED). A meta-analysis was performed to evaluate the results of the literature by random effect. Results Of the 1,218 carotid revascularizations performed in our institution, 706 (57.9%) were CEA and 512 (42.1%) were CAS. CED occurred in 3.6% of the CEAs and 8.2% of the CASs ( p = .001). CCO was present in 37 (5.2%) CEAs and 38 (7.4%) CASs. In CEA, CCO patients had a higher CED compared with the non-CCO patients (16.2% vs. 2.9%, p = .001), as confirmed by multiple regression analysis (OR [odds ratio]: 5.1[1.7–14.5]). In CAS, CED was not significantly different in the CCO and non-CCO patients (2.6% vs. 8.7%, p = 0.23). The comparative analysis of the CCO patients showed a higher CED in CEA compared with that in CAS (16.2% vs. 2.6%, p = 0.04). Meta-analysis of 33 papers (27 on CEA and 6 on CAS) revealed that CCO was associated with a higher CED in CEA, but not in CAS (OR: 1.82 [1.57–2.11]; OR: 1.22 [0.60–2.49], respectively). Conclusion CCO can be considered as a risk factor for CED in CEA, but not in CAS. CAS appears to be associated with lower CED than CEA in CCO patients.

Introduction Chronic oral anticoagulant therapy (OAT) is of widespread use, and usually its management in patients undergoing carotid artery stenting (CAS) is through perioperative bridging heparin therapy. Aim of the present study is to analyze a single center experience of CAS in patients maintaining OAT without perioperative bridging heparin therapy. Materials and methods A retrospective evaluation of consecutive patients submitted to CAS was performed. Clinical anatomical characteristics and chronic OAT were evaluated to find a correlation with stroke, death, myocardial infarction and bleeding from the access site by Chi-square, Fisher's tests and regression analysis. Results 502 CAS were performed in a 5-year period. Twelve (2.4%) strokes, 1 (0.2%) death, no myocardial infarctions and 4 (0.8%) access site bleeding occurred in the perioperative period. In the overall population the presence of type 3 or bovine aortic arch was associated with stroke (5.5% vs. 1.5% p = 0.02), and preoperative neurological ischemic symptoms were correlated with higher incidence of the composite event of stroke/death (4.8% vs. 1.4%, p = 0.05). Twenty patients (4.0%) under chronic OAT were submitted to CAS without perioperative bridging heparin therapy with no complications. Overall, patients under OAT had no significantly different outcome compared with patients without OAT. Conclusions OAT without perioperative bridging heparin therapy is safe and effective. This data could be useful in the management of patients with chronic OAT submitted to CAS.

Aim of the study In this study, we propose to use a thermal technique, Differential Scanning Calorimetry (DSC) to follow the evolution of elastin and collagen in safe and pathological cardiovascular tissues. Patients and methods The first part of this study deals with the analysis of the elastin network and associated proteins during ageing (from children to old persons) in aortic walls. The second part is devoted to the characterization of the collagenic phase in aneurysms. In both cases, physical data are correlated with biochemical analyses. Results and conclusion For old persons aortas with atheromatous stades, elastin and associated proteins are found to interpenetrate to form a homogenous phase. Abdominal aortic aneurysms (AAA) are characterized by structural alterations of the aortic wall resulting from the degradation of elastic fibers and an increase of collagen/elastin ratio. Notable modifications are evidenced between collagen from control tissue and collagen from AAA, particularly concerning the thermal denaturation. Biochemical and thermal results are compatible with the increase of new collagen deposition and/or impairment of the collagen phase stability in the extracellular matrix of AAAs.

Introduction Kissing balloon technique with two low-profile catheters (KBT) could be the treatment of choice for diseased infrapopliteal artery bifurcation in critical limb ischemia (CLI). Report From April to December 2006, 8 patients with CLI and tibial artery disease located in the infrapopliteal bifurcation were treated with KBT. Technical success was achieved in all patients without major or minor complications. Discussion Angioplasty of the bifurcation of the popliteal and tibio-peroneal trunk using KBT is a safe and effective procedure in CLI.

Proximal and distal carotid tortuosity is considered of paramount importance in carotid artery stenting (CAS) procedures. Specifically, distal internal carotid coiling or kinking is thought to interfere with proper distal protection devices, thus contraindicating CAS. The type of the aortic arch is also considered a key factor in CAS success; however, no standardized method of evaluation of these indicators is available in the literature. We have evaluated the impact of arch angulation and proximal and distal tortuosity in a series of CAS procedures.In patients undergoing CAS, arch angulation and tortuosity of both common and distal internal carotid arteries were evaluated prospectively by calculating the sum of all angles diverging from the ideal straight axis, considering a 90 degrees ideal angle for the origin from the arch (tortuosity index, TI). All procedures were through a transfemoral approach and with distal protection. Results were correlated with technical procedural success (residual stenosis30%) and neurologic complication by Student t test. Multivariate logistic regression analysis was conducted to identify independent predictors of results.In a group of 298 CAS procedures, the mean proximal TI was 111.9 degrees +/- 96.77 degrees and the mean distal TI was 123.4 degrees +/- 117.47 degrees . Technical success was obtained in 272 patients (91.2%). Causes for the 26 technical failures were incapacity to obtain stable proximal access in 25 (96.1%), and uncrossable stenosis in one (3.9%). Neurologic protection was achieved with distal filters in all cases. Neurologic complications occurred in 23 patients (7.7%), consisting of 16 transient ischemic attacks and seven minor strokes. The proximal TI was significantly greater in the 26 cases of technical failure (158.4 degrees +/- 102.2 degrees vs 107.6 degrees +/- 95.3 degrees , P = .01). The distal TI was not different in the two groups (89 degrees +/- 99.1 degrees vs 126.5 degrees +/- 118.6 degrees , P = .11). Similarly, the proximal TI was significantly greater in neurologic complications (162.8 degrees +/- 111.8 degrees vs 107.6 degrees +/- 18.2 degrees , P = .03); the distal TI was not different in the two groups (112.6 degrees +/- 110.1 degrees vs 124.3 degrees +/- 96.1 degrees , P = .5) By logistic regression analysis, a proximal TI150 was an independent predictor of both neurologic complications and technical failure. Age was also independently associated with technical failure. Appropriate distal filter placement was possible in all cases with a crossable stenosis, irrespective of the internal carotid TI.The proximal TI is significantly associated with both technical success and neurologic complications after CAS, whereas the distal TI did not influence either outcome. The presence of distal kinking or coiling should not be considered a contraindication to CAS.

Multiple reports advocate the use of infrapopliteal angioplasty for limb salvage; however, its utility in the setting of renal failure is unclear. We performed angioplasty, rather than bypass, for tibial stenoses or occlusions

Iatrogenic aortic injuries by pedicle screws are rare but serious complications of spinal fixation surgery. We report the case of a 55-year-old man who underwent surgical correction of traumatic thoracic vertebral fractures at another institution. At 6-month follow-up, computed tomography revealed a nonhealing of the fractures, and a T4 misplaced pedicle screw penetrating the descending thoracic aorta. The patient underwent open aortic repair associated with the anterior vertebral column reconstruction and posterior arthrodesis revision by a vascular and orthopedic surgery team simultaneously.