Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children: I. Procedure

Voiding urosonography (VUS) encompasses examination of the urinary tract with intravesical administration of US contrast agent (UCA) for diagnosis of vesicoureteric reflux (VUR). The real breakthrough for US examination of VUR came with the availability of stabilized UCAs in the mid-1990s. This article presents a comprehensive review of various procedural aspects of VUS. Different US modalities are available for detecting the echogenic microbubbles: fundamental mode, colour Doppler US, harmonic imaging and dedicated contrast imaging with multiple display options. The reflux is graded (1 to 5) in a similar manner to the system used in voiding cystourethrography (VCUG). The most commonly used UCA for VUS, Levovist, is galactose-based and contains air-filled microbubbles. The recommended concentration is 300 mg/ml at a dose of 5–10%, or less than 5%, of the bladder filling volume when using fundamental or harmonic imaging modes, respectively. There are preliminary reports of VUS using a second-generation UCA, SonoVue. Here the UCA volume is less than 1% of the bladder filling volume. There is no specific contraindication to intravesical administration of UCA. The safety profile of intravesical Levovist is very high with no reports of side effects over a decade of use in VUS

Distribution and Progression of Inflammatory Chorioretinal Lesions Related to Multifocal Choroiditis and Their Correlations with Clinical Outcomes at 24 Months

Purpose: To analyze distribution and progression of multifocal choroiditis (MFC) inflammatory lesions and their correlations with clinical outcomes at 24 months. Methods: Distribution and progression of inflammatory lesions were evaluated in eyes with MFC using a semi-automatic approach based on fundus autofluorescence. Twenty-four-months clinical outcomes were correlated with baseline features. Results: Twenty-five eyes from 20 patients were enrolled. Visual acuity (VA) significantly improved from baseline to 24 months. Chorioretinal lesions spared the fovea in most eyes. The area of inflammatory lesions at 24 months significantly increased. Final number and area of lesions were significantly influenced by baseline features. Inflammatory lesions enlarged over time regardless of MFC recurrences. New lesion and MFC relapses did not affect final outcomes. Conclusions: Final VA correlated with baseline VA. Scars resulting from MFC lesions enlarged overtime even when the disease was under control. New lesions and MFC relapses did not affect final outcomes

Two birds with one stone: transcatheter valve-in-valve treatment of a failed surgical bioprosthesis with concomitant severe stenosis and paravalvular leak

Implantation of bioprosthetic surgical valves has been a common procedure in elderly patients with severe aortic stenosis due to patients´ preferences avoiding anticoagulation therapy. However, this valve presents sometime certain deterioration degree (i.e., dysfunction due to stenosis or regurgitation) or even paravalvular leak. Transcatheter heart valve implantation is a good alternative in high-risk patients. The valve-in-valve procedure has been shown to be a safe and effective procedure. However, the presence of the fixed sewing ring of the surgical bioprosthesis can hamper appropriate expansion of the THV. For this reason, the use of cracking balloon seems to be a safe alternative to increase the effective orifice area. We present a case of a patient with a degenerated previous implanted biological valve and paravalvular leak. We used the treatment strategy of valve-in-valve with post-dilatation with high-pressure balloon, in a way to treat both, the degenerated valve and the paravalvular leak. The use of a single percutaneous procedure was enough and safe to treat both problems without further complications

New devices to cross chronic total occlusion in critical limb ischemia

Chronic total occlusions (CTos) represent a technically demanding subset of lesions, which in most cases require special endovascular methods, advanced operator skills, and utilization of sophisticated assisting devices for successful treatment. CTo crossing devices offer an additional option to interventionists in the treatment of challenging lower extremity peripheral arterial occlusions. These devices may improve crossing rates, allowing delivery of therapeutic devices to the target lesion. initial technical results seem quite promising, although adequate data on patient and device selection are lacking. until long-term clinical data verify the durability of those techniques, these devices must be used in a stepwise fashion in selected patients with Cli. © 2016 Edizioni Minerva Medica

The Incidence of Neovascularization in the Fellow Eye of Patients with Unilateral Choroidal Lesion : a Survival Analysis

Purpose: To compare the difference in the rate of survival of unaffected fellow eyes between choroidal neovascularization (CNV) in the first eyes and retinal angiomatous proliferation (RAP) in the first eyes. Design: Cohort retrospective study. Participants: A total of 329 consecutive patients enrolled in our Eye Clinic between February 2006 and November 2014 were involved in the study. Only patients with na\uefve unilateral forms of neovascularization in 1 eye were included in this study. Methods: A clinical database containing patients\u2019 data and ocular history was evaluated. Only patients with naive lesions in 1 eye and without signs of neovascular AMD in the fellow eye were included in the analysis. The time of absence of neovascularization in the fellow eye was calculated. Main Outcome Measures: Survival of the fellow eye was estimated by Kaplan\u2013Meier analysis, and log-rank test was used to compare CNV and RAP fellow eye survival. Results: A total of 202 eyes affected by CNV and 39 eyes affected by RAP were enrolled in the study. The mean follow-up time was 2.9 years (range, 182\u20132461 days) for CNV and 2.6 years (range, 519\u20131504 days) for RAP. Kaplan\u2013Meier analysis showed that the 50% of the fellow eyes with CNV did not develop neovascularization for 5.3 years, whereas the 50% of the fellow eyes with RAP did not develop neovascularization for 3.5 years. Log-rank test showed a highly significant difference between the 2 curves (P < 0.002). Conclusions: This study showed that the incidence of neovascularization in the unaffected fellow eye increases with time, and when the first eye is affected by RAP, the development of a lesion in the second eye is more premature

Comparison of latest generation supra-annular and intra-annular self-expanding transcatheter heart valves

Background This study compares two latest-generation self-expanding transcatheter heart valves (THV), the supra-annular ACURATE neo (Boston Scientific) and the intra-annular Centera THV (Edwards Lifesciences). Methods In this single center observational cohort trial 317 patients treated with the ACURATE neo and 78 patients treated with the Centera TVH were included. The main endpoints were device success and the early safety endpoint at 30 days. Results Besides higher incidence of diabetes mellitus and higher body mass index in patients treated with the ACURATE neo THV, there were no baseline differences between the groups. Device success was similar in both groups (neo: 91.8% vs. Centera: 93.6%; P=0.598), with numerically higher rates of moderate to severe paravalvular leakage in the ACURATE neo group (4.7% vs. 1.3%; P=0.214). At 30 days all-cause mortality rates were low in both groups (0.3% vs. 0%; P=0.620) and no difference occurred in the early safety at 30 days (19.3% vs. 16.7%; P=0.599). However, all-cause stroke rates were significantly higher in patients treated with the Centera THV (6.4 vs. 1.6%; P=0.015). Conclusions The ACURATE neo and the Centera THV show low mortality rates as well as comparable, favorable hemodynamics. The finding of higher stroke rates at 30 days with the repositionable Centera SE-THV needs further assessment

Safety and efficacy of the Yukon Choice Flex sirolimus-eluting coronary stent in an all-comers population cohort

Aims: The use of biodegradable-polymer drug-eluting stents has been shown to provide favorable results when compared with durable polymer drug-eluting stents and long-term follow up data have recently shown significant reductions in terms of very late stent thrombosis. Aim of the present study was to assess the safety and efficacy profile of a novel biodegradable polymer DES, the Yukon Choice Flex sirolimus-eluting stent. Methods: We report here the one-year clinical outcomes associated with the use of the Yukon Choice Flex sirolimus-eluting stent in an all-comers patient population. The present stent represents a further refinement of the stent platform tested in the ISAR TEST 3 and 4 randomized clinical trials. A total of 778 consecutive patients undergoing implantation of this stent were enrolled in the present observational study and prospectively followed for one year. Results: The use of the Yukon Choice Flex stent in a patient population with complex coronary lesion morphology was associated with optimal immediate angiographic results. At one year follow up the rates of death, myocardial infarction, definite stent thrombosis and ischemia-driven target lesion revascularization were respectively 2.4%, 1.9%, 0.3% and 11.3%. Conclusions: The use of the sirolimus-eluting biodegradable polymer Yukon Choice Flex stent in an all-comers population of patients with complex coronary artery disease is associated with a favorable safety and efficacy profile up to one year follow up