Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts.

AIM: To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS: A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS: There were no differences between the two groups with regard to patient demographics, except for the number of previous vascular procedures (n=6.83 ± 3.07 direct approach versus n=4.96 ± 2.79 native vessel approach, p=0.025). Thrombolysis was comparably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION: The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach.

Coil Embolization of True, Common and Proper, Hepatic Artery Aneurysms: Technique, Safety and Outcome.

PURPOSE: To retrospectively assess the safety and efficacy of coil embolization for catheter-directed true common and proper hepatic artery aneurysm exclusion. MATERIALS AND METHODS: Nine consecutive patients (2005-2021) in two university centers presenting with true common and proper hepatic artery aneurysms (> 2 cm in diameter) were treated with 'frontdoor-backdoor' coil embolization. Patients presenting with a hepatic artery pseudoaneurysm, mycotic aneurysm or patients with small (< 2 cm diameter) aneurysms and followed up by imaging were excluded. Technical and clinical success was defined as complete coil-exclusion of the aneurysm on completion angiography and absence of post-embolization adverse events, in particular mass effect or hemorrhage, respectively. Patient characteristics, technical and clinical success, liver function tests and follow-up results were assessed based on the patients' electronic medical records. RESULTS: Technical and 30-day clinical success was achieved in all procedures (100%). No major procedural complications were reported. Liver function test values were available in 6/9 patients, showing transient elevation of bilirubin in one patient. No end organ ischemia was reported. The mean clinical follow-up period of the study patients was 72 months (12-168 months). Long-term stable occlusion of the hepatic aneurysms was achieved in 9/9 patients (100%). One patient showed late complication (3 years) with coil migration into a bulbar ulcer, without aneurysm recanalization, however with fatal outcome. CONCLUSION: Coil embolization for the endovascular exclusion of true common and proper hepatic artery aneurysms is safe and effective.

Negative-pressure wound therapy for the treatment of pharyngocutaneous fistula.

INTRODUCTION: Pharyngocutaneous fistula is a well-known complication of head and neck cancer surgery.The purpose of this study was to determine the value of negative-pressure wound therapy (NPWT) for the treatment of these fistulas. NPWT is used in many fields of medicine, but its use in otorhinolaryngology has been rarely reported. NPWT is a cost-effective means to accelerate wound healing. PATIENTS AND METHODS: A single-centre retrospective study was conducted on 7 patients with pharyngo-cutaneous fistula following surgery for squamous cell carcinoma between January 2011 and April 2013.These fistulas were treated by negative-pressure wound therapy (NPWT). RESULTS: This series comprised seven male patients with a mean age of 65 years and 9 months. The mean duration of treatment was 23 days (range: 11 to 42 days). Two patients had a history of radiotherapy for pharyngolaryngeal cancer. Negative-pressure wound therapy achieved cure of the fistula in all patients with satisfactory acceptability. Mean follow-up was 10 months (range: 6 months to 2 years). CONCLUSION: Negative-pressure wound therapy represents a valuable treatment option in certain settings for the management of pharyngocutaneous fistula following head and neck cancer surgery.

Clinical-radiological correlation after functional endoscopic sinus surgery in patients with chronic rhinosinusitis: interest of a sinonasal aerial volumetry.

BACKGROUND: Although a CT scan is often performed after functional endoscopic sinonasal surgery (FESS) in patients with chronic rhinosinusitis, its role hasn`t been firmly established. The goal of this study is to investigate the correlation between symptoms and CT findings before and after FESS for chronic rhinosinusitis. In addition, the interobserver agreement for both sinonasal aerial volumetry and CT score is assessed. METHODS: Thirty-three patients surgically treated for chronic rhinosinusitis were included in this prospective study. Conventional and modified Lund-Mackay scores and sinonasal volumetry were determined by two radiologists before (M0), at 3 months (M3) and 1 year (M12) after surgery. The symptoms were evaluated by the 22-item SinoNasal Outcome Test (SNOT-22). RESULTS: Change of SNOT-22 and air volume were significantly correlated between M0 and M12, but not between M0 and M3, for both readers. Compared to other scores, volume had the best intraclass correlation coefficient and reproducibility, according to the Bland-Altman analysis. No correlation was found between SNOT-22 and CT scores before and after surgery, except between M12 and M0 for one reader. CONCLUSION: The correlation between CT scan and symptoms is low or absent. The measurement of sinonasal air volume is best correlated with the symptoms after surgery, with the best inter-observer agreement.

Prospective study on the efficacy of optokinetic training in the treatment of seasickness.

OBJECTIVES: Seasickness corresponds to all of the clinical symptoms experienced by a subject at sea related to boat movements. The objective of this study was to evaluate the efficacy of optokinetic training versus placebo in the treatment of seasickness. MATERIAL AND METHODS: Fifteen subjects were randomized to either an optokinetic training arm or a placebo arm. The impact of seasickness was evaluated for each subject before and after optokinetic training using the Graybiel scale. RESULTS: Among the trained subjects, 71.4% were improved by optokinetic training versus 12.5% of control subjects. A significant difference was observed for Graybiel scores before and after optokinetic training in the training arm. CONCLUSION: Optokinetic training appears to be an effective modality for the management of disabling seasickness. This training can be further improved by more global patient management.

Optokinetic stimulation rehabilitation in preventing seasickness.

OBJECTIVES: Seasickness occurs when traveling on a boat: symptoms such as vomiting are very disturbing and may be responsible for discontinuing travel or occupation and can become life-threatening. The failure of classical treatment to prevent seasickness has motivated this retrospective study exploring optokinetic stimulation in reducing these symptoms. PATIENTS AND METHODS: Experimental training of 75 sailors with optokinetic stimulation attempted to reduce seasickness manifestations and determine the factors that could predict accommodation problems. RESULTS: Eighty percent of the trained subjects were able to return on board. No predictive factors such as sex, occupation, degree of illness, number of treatment sessions, time to follow-up, and age were found to influence training efficacy. CONCLUSION: Optokinetic stimulation appears to be promising in the treatment of seasickness. Nevertheless, statistically significant results have yet to demonstrate its efficacy.

[Incidence of vertigo in diving]. / Incidence des vertiges en plongée sous marine.

Vertigo is relatively common after diving. Although it may be the result of the changes in pressure, it can also be a feature of decompression accidents, of clinical toxicity, simply be a manifestation of altered physiology resulting from immersion in a weightless environment in which all the organs involved in maintaining equilibrium (vestibular system, proprioception and vision) are affected. It seemed to us to be of interest to study the incidence of vertigo in naval divers by means of an anonymous questionnaire. The responses were elicited over a 3 month period from 333 divers. 45 divers reported clinical sensations of vertigo, an incidence of 13.5%. If this figure is related to the number of dives, the incidence falls to 0.06%. No decompression accidents were reported. The main aetiology was barotrauma, 42% being of alternobaric and 36% of pressure type. The remaining aetiologies were sensory illusions in 6% of cases, and other non-ENT causes in 16%. After a review of the physiopatholgy and study of the case hisotries, there is a discussion of the features which allow the aetiology to be determined and treatment planned.