Endovascular Treatment of Renal Artery Bifurcation Stenoses with Branched Balloon Angioplasty

An 85-year-old man with left sided single kidney presented with end-stage renal failure after an acute intestinal bleeding. A complex bifurcational stenoses distally to a 6 months previously implanted ostial stent in the left renal artery was found on duplex imaging and angiogram. These two de-novo stenoses in the distal main renal artery and the proximal segment of the lower branch were simultaneously treated with a ultra-low profile, monorail bifurcation balloon catheter system (Avion Bifurcation RX2™, Invatec, Italy) that consists of a main vessel balloon (20/3.5mm) and a side vessel balloon (20/2.75mm). One day and three months postinterventionally, duplex ultrasound demonstrated no recurrent stenoses. Bifurcation balloon catheter systems for complex renal artery stenosis are discussed

Conditions currently associated with erythema nodosum in Swiss children

A review was made of the 36 paediatric patients in whom the diagnosis of erythema nodosum had been established between 1977 and 1996 at the Department of Paediatrics, University of Bern, Switzerland. Infectious diseases were associated with erythema nodosum in 20 (including 10 streptococcal infections) and non-infectious inflammatory diseases in 8 patients. None of the 36 patients had tuberculosis or had been exposed to sulphonamides, phenytoin or hormonal contraceptives. There were eight patients in whom either the associated disease was not diagnosed, or there was no other disease. Conclusion Most cases of erythema nodosum are nowadays caused by non-mycobacterial infectious diseases or by non-infectious inflammatory disease

Cognitive function in patients with peripheral artery disease: a prospective single-center cohort study

AIM The aim of the present study was to examine the association between cardiovascular comorbidities and risk factors, and cognitive function in PAD patients and to determine the influence of cognitive function on cardiovascular outcome in a two--year follow--up. METHODS The cognitive function of 104 PAD patients was assessed using the mini--mental test (MMSE). Ankle brachial index (ABI), Fontaine stage, PAD localisation, cardiovascular risk factors and comorbidities were taken from the electronic patient charts. A multiple logistic regression model, which included MI, stroke/TIA, DM, CHD and smoking was performed to compare patients with and without cognitive impairment. All study participants were followed for two years in order to evaluate their cardiovascular outcome, mortality and revascularisation rate. RESULTS There was no significant difference in mini--mental state between asymptomatic and symptomatic PAD patients. ABI and PAD localisation was not related to cognitive function. However, pre--existing stroke, transient ischemic attack, coronary artery disease (CAD) or diabetes mellitus were associated with a lower mini--mental test score. When MMSE was dichotomized in ≤ 27 and >27 points, the presence of coronary artery disease, history of cerebrovascular events and diabetes mellitus was associated with a MMSE ≤ 27 in multivariate analysis There was no association between MMSE and cardiovascular event rate. CONCLUSION PAD patients with coronary artery disease, stroke, transient ischemic attack or diabetes mellitus have worse cognitive function than those without these factors. There was no evidence that cognitive function influenced cardiovascular outcome

Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation

Abstract. Background: Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. Patients and methods: Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0 = not at all, 10 = very much). Adverse events during the treatment were monitored. Results: 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0 - 6) compared to the controls (mean 4.3 points, range 1 - 9, p &lt; 0.001). Overall, 64.5 % of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). Conclusions: N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA. </jats:p

Cognitive function in patients with peripheral artery disease: a prospective single-center cohort study

AIM The aim of the present study was to examine the association between cardiovascular comorbidities and risk factors, and cognitive function in PAD patients and to determine the influence of cognitive function on cardiovascular outcome in a two--year follow--up. METHODS The cognitive function of 104 PAD patients was assessed using the mini--mental test (MMSE). Ankle brachial index (ABI), Fontaine stage, PAD localisation, cardiovascular risk factors and comorbidities were taken from the electronic patient charts. A multiple logistic regression model, which included MI, stroke/TIA, DM, CHD and smoking was performed to compare patients with and without cognitive impairment. All study participants were followed for two years in order to evaluate their cardiovascular outcome, mortality and revascularisation rate. RESULTS There was no significant difference in mini--mental state between asymptomatic and symptomatic PAD patients. ABI and PAD localisation was not related to cognitive function. However, pre--existing stroke, transient ischemic attack, coronary artery disease (CAD) or diabetes mellitus were associated with a lower mini--mental test score. When MMSE was dichotomized in ≤ 27 and >27 points, the presence of coronary artery disease, history of cerebrovascular events and diabetes mellitus was associated with a MMSE ≤ 27 in multivariate analysis There was no association between MMSE and cardiovascular event rate. CONCLUSION PAD patients with coronary artery disease, stroke, transient ischemic attack or diabetes mellitus have worse cognitive function than those without these factors. There was no evidence that cognitive function influenced cardiovascular outcome