Added Value of Computed Tomography Angiography Prior to Bronchial Artery Embolization for Hemoptysis: A Retrospective Two-Center Study

Objectives: The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis. Materials and Methods: In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality. Results: We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported. The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045). The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group. Conclusions: Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed

Radiation Segmentectomy, Radiation Lobectomy and Response Assessment after 90Yttrium Radioembolization for Hepatocellular carcinoma: Imaging and Clinical Implications

Hepatocellular carcinoma is a primary liver cancer.Among treatment options for hepatocellular carcinoma, Yttrium-90 radioembolization is a promising transarterial therapy.This thesis investigates potential clinical applications of radioembolization in the treatment of the hepatocellular carcinoma (techniques of radiation segmentectomy and radiation lobectomy), and adress the problematic of the response Assessment after radioembolization.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe

Haemoptysis treated by bronchial artery embolisation in severe acute respiratory syndrome coronavirus 2: case report

Background: We found no data in the literature on the embolization of the bronchial arteries in the context of hemoptysis associated with severe acute respiratory syndrome coronavirus 2. We therefore decided to share this experience. Case presentation: A 62-year-old patient with no significant medical history was admitted with acute respiratory distress. Chest computed tomography showed diffuse bilateral ground-glass opacities with limited consolidations. Diagnostic tests confirmed severe acute respiratory syndrome coronavirus 2 infection. The severity of respiratory failure required the implantation of veno-venous extracorporeal membrane oxygenation. The patient developed severe haemoptysis, which was successfully treated by bronchial artery embolisation. Conclusions: In the case of coronavirus-19 pneumonia, our experience suggests that the treatment of severe haemoptysis by bronchial artery embolisation is feasible and effective. The survival benefit should be assessed in the future.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Endovascular management of a rare complication of an aortic coarctation

A 28-year-old pregnant woman presents with arterial hypertension of the upper limbs. The examination suggests an aortic coarctation. After a normal delivery, a contrast-enhanced computed tomography revealed a subocclusive aortic coarctation of the descending thoracic aorta and a 33-mm aneurysm developed from the left cervical-thoracic artery. The coarctation of the aorta was treated by a stent graft, and the aneurysm was treated by an injection of thrombin and glue.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Long-term outcomes of laparoscopic adjustable gastric banding

Objective: To determine the long-term efficacy and safety of laparoscopic adjustable gastric banding (LAGB) for morbid obesity. Design: Clinical assessment in the surgeon's office in 2009 (≥12 years after LAGB). Setting: University obesity center in Brussels, Belgium. Patients: A total of 151 consecutive patients who had benefited from LAGB between January 1, 1994, and December 31, 1997, were contacted for evaluation. Intervention: Laparoscopic adjustable gastric banding. Main Outcome Measures: Mortality rate, number of major and minor complications, number of corrective operations, number of patients who experienced weight loss, evolution of comorbidities, patient satisfaction, and quality of life were evaluated. Results: The median age of patients was 50 years (range, 28-73 years). The operative mortality rate was zero. Overall, the rate of follow-up was 54.3% (82 of 151 patients). The long-term mortality rate from unrelated causes was 3.7%. Twenty-two percent of patients experienced minor complications, and 39% experienced major complications (28% experienced band erosion). Seventeen percent of patients had their procedure switched to laparoscopic Roux-en-Y gastric bypass. Overall, the (intention-to-treat) mean (SD) excess weight loss was 42.8% (33.92%) (range, 24%-143%). Thirty-six patients (51.4%) still had their band, and their mean excess weight loss was 48% (range, 38%-58%). Overall, the satisfaction index was good for 60.3% of patients. The quality-of-life score (using the Bariatric Analysis and Reporting Outcome System) was neutral. Conclusion: Based on a follow-up of 54.3% of patients, LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. Of 78 patients, 47 (60.3%) were satisfied, and the quality-of-life index was neutral. However, because nearly 1 out of 3 patients experienced band erosion, and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%), LAGB appears to result in relatively poor long-term outcomes. ©2011 American Medical Association. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Diagnosis, pathophysiology, and treatment of SIRT-induced gastroduodenal ulcers: A systematic literature review

Background: Selective Internal Radiation Therapy (SIRT) is a therapeutic modality in patients with hepatocellular carcinoma or liver metastases. Complications due to SIRT-induced gastric ulcers are seen in less than 5% of patients but there is no consensus for management of this rare side effect. We conducted a systematic review to analyze the efficacy of medical treatment of SIRT-induced ulcers. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. We developed the research question following the population, intervention, comparison, outcome, and study design (PICOS) format. We identified studies and cases reporting patients with gastric and/or duodenal (=population) ulcers treated with medical therapy with proton pump inhibitor (PPI), antacid, or sucralfate, alone or in combination (=intervention). We did not require that studies include a control group. We included studies reporting the evaluation of the medical and/or surgical treatment (=outcomes). Results: Out of 219 articles, 29 articles were included, resulting in analysis of data for a total of 51 patients who had a SIRT-induced gastric and/or duodenal ulcer treated with medication, surgery, or both. Twenty-eight patients (55%) were reported to have SIRT-induced ulcers that improved after initiation of PPI, antacid, or sucralfate treatment (alone or in combination). Twenty-three patients (45%) were reported to be refractory to medical treatment and surgery was performed in 7 out of 23 patients (30%). Conclusions: About 45% of SIRT-induced gastroduodenal ulcers are refractory to medical treatment with PPI, antacid, or sucralfate, alone or in combination. Surgery is an effective treatment in patients who are refractory to medical treatment and who have intense symptoms.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Intra- and interobserver reproducibility of pancreatic perfusion by computed tomography

The aim of this study was to measure intra- and interobserver agreement among radiologists in the assessment of pancreatic perfusion by computed tomography (CT). Thirty-nine perfusion CT scans were analyzed. The following parameters were measured by three readers: blood flow (BF), blood volume (BV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was performed using the Bland-Altman method, linear mixed model analysis, and intraclass correlation coefficient (ICC). There was no significant intraobserver variability for the readers regarding BF, BV or TTP. There were session effects for BF in the pancreatic body and MTT in the pancreatic tail and whole pancreas. There were reader effects for BV in the pancreatic head, pancreatic body and whole pancreas. There were no effects for the interaction between session and reader for any perfusion parameter. ICCs showed substantial agreement for the interobserver measurements and moderate to substantial agreement for the intraobserver measurements, with the exception of MTT. In conclusion, satisfactory reproducibility of measurements was observed for TTP in all pancreatic regions, for BF in the head and BV in the tail, and these parameters seem to ensure a reasonable estimation of pancreatic perfusion.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Are laparoscopic gastric bypass after gastroplasty and primary laparoscopic gastric bypass similar in terms of results?

Background: This retrospective study compares the results of primary gastric bypass (PGB) versus secondary gastric bypass (SGB) performed after gastroplasty. Methods: Between January 2004 and August 2008, 576 consecutive patients benefited from laparoscopic gastric bypass (LGB) in our hospital. Four hundred seventy patients (81.6%) were available for full evaluation. Primary outcome measures were operative time, conversion to open surgery and mortality, hospital stay, early and late complications, reoperations, efficacy, and patient satisfaction. Results: Three hundred sixty-two patients benefited from a PGB and 108 from SGB. Median preoperative BMI was 42 kg/m2 (34.8-63.5; PGB) and 39 kg/m2 (20.9-64.5; SGB; p = 0.002). Median operative time was 109 min (40-436; PGB) and 194 min (80-430; SGB; p < 0.001). There was no conversion to open surgery or mortality in either group. Median hospital stay was 4 days (3-95; PGB) and 5 days (2-114; SGB; p < 0.001). Early complications were recorded in 37 patients (10.2%) after PGB and in 24 patients (22.2%) after SGB (p<0.001). Reoperation was necessary in 12 patients (3.3%) after PGB and in 9 patients (8.3%) after SGB (p=0.03). Median follow-up was 35 months (12-66; PGB), and 34 months (12-66; SGB; NS). Late complications were achieved in 46 patients (12.7%) after PGB and in 33 patients (30.6%) after SGB (p<0.001). Reoperation was necessary in 17 patients (4.7%) after PGB and in 11 patients (10.2%) after SGB (p=0.03). Mean %EWL was 74.2% after PGB and 69.9% after SGB (NS). After PGB, 89% of the patients was satisfied, 4% neutral, and 6% unsatisfied; after SGB, 79% was satisfied, 10% neutral, and 11% unsatisfied (p=001). Conclusions: Weight loss after PGB and SGB is not statistically significantly different. Otherwise, operative time, hospital stay, complications, and revision rate are statistically significantly higher after SGB (p < 0.001). © 2010 Springer Science + Business Media, LLC.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

New Imaging Techniques for 90Y Microsphere Radioembolization

http://www.omicsonline.org/2155-9619/2155-9619-2-113.phpinfo:eu-repo/semantics/publishe

Combined quality and dose-volume histograms for assessing the predictive value of 99mTc-MAA SPECT/CT simulation for personalizing radioembolization treatment in liver metastatic colorectal cancer

Abstract Background The relationship between the mean absorbed dose delivered to the tumour and the outcome in liver metastases from colorectal cancer patients treated with radioembolization has already been presented in several studies. The optimization of the personalized therapeutic activity to be administered is still an open challenge. In this context, how well the 99m Tc-MAA SPECT/CT predicts the absorbed dose delivered by radioembolization is essential. This work aimed to analyse the differences between predictive 99m Tc-MAA-SPECT/CT and post-treatment 90 Y-microsphere PET/CT dosimetry at different levels. Dose heterogeneity was compared voxel-to-voxel using the quality-volume histograms, subsequently used to demonstrate how it could be used to identify potential clinical parameters that are responsible for quantitative discrepancies between predictive and post-treatment dosimetry. Results We analysed 130 lesions delineated in twenty-six patients. Dose-volume histograms were computed from predictive and post-treatment dosimetry for all volumes: individual lesion, whole tumoural liver (TL) and non-tumoural liver (NTL). For all dose-volume histograms, the following indices were extracted: D 90 ,D 70 ,D 50 ,D mean and D 20 .The results showed mostly no statistical differences between predictive and post-treatment dosimetries across all volumes and for all indices. Notably, the analysis showed no difference in terms of D mean ,confirming the results from previous studies. Quality factors representing the spread of the quality-volume histogram (QVH) curve around 0 (ideal QF = 0) were determined for lesions, TL and NTL. QVHs were classified into good (QF < 0.18), acceptable (0.18 ≤ QF < 0.3) and poor (QF ≥ 0.3) correspondence. For lesions and TL, dose- and quality-volume histograms are mostly concordant: 69% of lesions had a QF within good/acceptable categories (40% good) and 65% of TL had a QF within good/acceptable categories (23% good). For NTL, the results showed mixed results with 48% QF within the poor concordance category. Finally, it was demonstrated how QVH analysis could be used to define the parameters that predict the significant differences between predictive and post-treatment dose distributions. Conclusion It was shown that the use of the QVH is feasible in assessing the predictive value of 99m Tc-MAA SPECT/CT dosimetry and in estimating the absorbed dose delivered to liver metastases from colorectal cancer via 90 Y-microspheres. QVH analyses could be used in combination with DVH to enhance the predictive value of 99m Tc-MAA SPECT/CT dosimetry and to assist personalized activity prescription.info:eu-repo/semantics/publishe