Gastric Embolization as Treatment for Overweight Patients; Efficacy and Safety.

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of left gastric artery (LGA) embolization for the treatment of overweight patients who weren't candidates for bariatric surgery. MATERIALS AND METHODS: We retrospectively collected data of 16 patients who underwent a selective embolization of the LGA. The mean body mass index (BMI) before intervention was 28.9 kg/m2 ± 2.5, and therefore, patients were not candidates for bariatric surgery in Belgium. The embolization was realized with 500-700 µm particles via the right common femoral artery approach. Before and following the intervention, an upper endoscopy was performed. Patient demographics, weight loss, hunger sensation and a satisfactory scale were reviewed. RESULTS: Between February 2015 and May 2017, 16 overweight patients were treated, one embolization was unsuccessful. Four (25%) patients were lost in follow-up. Nine (56%) patients showed early weight loss, one (6%) maintained his bodyweight and one (6%) patient underwent bariatric surgery 2 years after consultation. Only one (6%) patient had a gastric ulceration on control endoscopy. One (6%) patient ended in the intensive care unit for pancreatitis and gastric perforation. The mean weight loss was 8 kg ± 5.12, reducing their mean BMI to 25.5 ± 3.5. The hunger sensation was decreased, and patients were satisfied. CONCLUSION: This is a preliminary study in an overweight population that appears to induce weight loss and appetite suppression. Larger studies are needed to confirm these preliminary findings.

[Sonography of peripheral nerves. Part II: lower limbs]. / Echographie des nerfs périphériques -- Deuxième partie: membre inférieur.

On sonographic images, the peripheral nerves have a fibrillary structure, ribboned on longitudinal images and ovoid on cross-section images. The nerves travel between the muscle groups, often with blood vessels, or in canals. Recently improved ultrasound devices are able to investigate the peripheral nerves along their entire length, as far as the sonographer has thorough anatomical knowledge, rigorous technique, and, when searching for pathology, good clinical notions. As in Part I on sonography of the peripheral nerves of the upper limbs, published in this journal, the objective of this general review is to present normal and pathological echoanatomy of the peripheral nerves of the lower limbs in an educational way.

MR imaging, proton MR spectroscopy, ultrasonographic, histologic findings in patients with chronic lymphedema.

Lymphedema is a progressive disease with multiple alterations occurring in the dermis. We undertook this study using high-frequency ultrasonography (US), magnetic resonance imaging, proton MR spectroscopy and histology to examine structural changes occurring in the subcutaneous tissue and precisely describe the nature of intralobular changes in chronic lymphedema. Four cutaneous and subcutaneous tissue biopsies from patients with chronic lymphedema during lymphonodal transplantation were studied. We performed US with a 13.5 MHz transducer, TSE T1 and TSE T2 magnetic resonance images with and without fat-suppression, MR Chemical Shift Imaging Spectroscopy and histological evaluation on these biopsies. We found that normal subcutaneous septa are seen as hyperechogenic lines in US and hyposignal lines in MRI and that hyperechogenic subcutis in US can be due to interlobular and intralobular water accumulation and/or to interlobular and intralobular fibrosis. Our study also confirms the usefulness of MR spectroscopy to assess water or fat content of soft tissue. Thus, multiple imaging modalities may be necessary to precisely delineate the nature of tissue alterations in chronic lymphedema.

Spontaneous renal artery dissection in an otherwise healthy male.

Dissection of a renal artery is rare and, in most cases, associated with underlying arterial diseases. Spontaneous renal artery dissection (RAD) is exceptional. We report the case of a young and otherwise healthy man with an isolated dissection of the right renal artery without any obvious origin. Diagnosis was made by angiography. He received medical treatment and rapidly recovered. Renal artery dissection can be misdiagnosed because its clinical presentation may be confusing. Selective renal angiography is essential to evaluate the extent of the dissection and the suitability for repair. Control of the hypertension and renal function preservation are the two main goals of the treatment. The place of surgical repair remains unclear because of the poor results on hypertension improvement and high complication rate.

Results of a European multicentre iliac stent trial with a flexible balloon expandable stent.

PURPOSE: to determine the 12 months success rate with a balloon expandable, flexible stainless steel stent in iliac artery obstructions. MATERIALS AND METHODS: one-hundred and twenty-six consecutive patients with iliac obstructive disease and who demonstrated an unsatisfactory angioplasty result with a post-dilatation gradient of at least 10 mmHg, or a primary occluded lesion were included in the study. Follow-up was by Doppler sonography, ankle pressures with and without exercise and clinical parameters. RESULTS: after stent placement, the mean percentage diameter stenosis decreased from 79 to 4%, with a mean intra-arterial pressure gradient of 3 mmHg. Primary stent patency was 94% at 6 months and 89% at 12 months. Primary clinical result at 6 months was 88% and at 12 months 81%. Primary assisted clinical result (after re-pta) at 6 and 12 months was 89 and 86%, respectively. The Ankle Brachial Index (ABI) after exercise at 1 month follow-up was reduced from 0.88 to 0.75, with minor deterioration at 6 months to 0.72, and at 12 months to 0.68. The 1, 6, and 12 months follow-up Piek Systolic Velocity (PSV) ratios across the stented lesions remained stable at a mean of 1.4, 1.6, and 1.6, respectively. However, respectively 44, 39 and 34% of the patients still experienced symptoms of claudication. CONCLUSIONS: the results presented here support the suggestion stenting to be an effective device in the treatment of iliac artery obstructive disease. This study also, confirms other study results concerning haemodynamic patency after iliac stenting on the indication of a 10 mmHg pressure gradient after pta and the discrepancy between good haemodynamic patency and clinical result.

Cholecystoduodenal fistula in a porcelain gallbladder.

Calcification of the gallbladder wall (porcelain gallbladder) is rare. Its appearance is quite characteristic on plain films, ultrasonography and computed tomography. Sporadic cases of cholecystitis have been described in porcelain gallbladders. Enterobiliary fistula may complicate acute or chronic cholecystitis in non-calcified gallbladder. We report a unusual case of acute cholecystitis with cholecystoduodenal fistula in a porcelain gallbladder.

[Doppler study of gluteal arteries. A useful tool for excluding gluteal arterial pathology snd an important adjunct to lower limb Doppler studies]. / Le Doppler des artères fessières. Un outil efficace pour exclure une pathologie artérielle fessière et un complément important du Doppler des membres inférieurs.

PURPOSE: 1) To determine the negative predictive value (VPN) of duplex scan in patients complaining of buttock or hip pain and thereby to distinguish vascular claudication from other musculoskeletal or neurological diseases. 2) To show its complementarity in doppler investigation of lower limb arteries. MATERIALS AND METHODS: Prospective study by duplex scan and arteriography of 60 gluteal arteries in 30 consecutive patients referred to check up for lower limb arteriopathy or sexual impotence. Duplex scan was performed by posterior approach. Correlation between doppler ultrasound and arteriography was studied. RESULTS: The study of normal arteries was possible in all cases and only one normal gluteal artery could not be detected in a diabetic overweight patient. On 60 arteries, sensitivity of duplex was 100 percent, specificity 96 percent and VPN 100 percent. Significant obstructive lesions were always associated with pathological velocimetric waveform or were not detected. CONCLUSIONS: Buttock claudication can appear like a typical vascular claudication or mimic neurological or musculoskeletal diseases. It is very useful to rule out a vascular causality responsible for buttock or hip pain by simple, non-invasive and cheap exploration. A normal doppler ultrasound of gluteal arteries can rule out vascular disease responsible for buttock or hip pain thereby avoiding arteriography. The strategy of diagnostic or therapy can be modified by such additional information as shown in two case reports.

US demonstration of a thrombosed persistent median artery in carpal tunnel syndrome.

Median artery of the forearm and wrist is not very frequently observed because it normally involutes before birth. Only a few cases of persistent median artery thrombosis associated with compression of the median nerve in the carpal tunnel have been reported. In these cases symptoms arise suddenly and surgery consists of the excision of the thrombosed arterial branch. In cases of large persistent unthrombosed median artery associated with carpal tunnel syndrome (CTS), excision of the unthrombosed median artery is not indicated because it may sometimes substantially contribute to the circulation of the hand. We report the case of a 39-year-old man with CTS associated with a thrombosis of a persistent median artery detected by high-resolution US and Doppler ultrasound. US can be also useful to exclude other causes of CTS such as tenosynovitis of the flexor tendons, ganglion cyst, musculotendinous variants, and various soft tissue tumors.

[Isolated idiopathic amyloid tumor of the sacrum. An important differential diagnosis]. / Amyloïdome solitaire idiopathique du sacrum. Un diagnostic différentiel important.

Primary amyloidosis may present as a pseudotumoral mass. Often associated with myeloma or paraproteinemia, it may also be isolated, without preexisting or associated disease. Isolated pseudotumoral bone involvement is rare and especially in the spine. Differential diagnosis is very important, because the prognosis of primary amyloidoma is excellent after surgical removal.

[Multislice computed tomography in clinical practice]. / La tomodensitométrie multibarrette en pratique clinique.

This paper presents our first experience with multislice computed tomography emphasizing our technical protocols. Between November 1999 and October 2000, 8086 multislice computed tomographic examinations were performed. The choice in collimation, pitch, slice width and increment, multiplanar reconstructions and contrast enhancement were adapted to provide high resolution in the Z axis, high speed acquisitions and low exposure to the patient. Filming and archiving parameters are also detailed. Multislice CT provides excellent 3D imaging with high speed acquisitions and lower doses than previously reported with single slice CT.

[Right ventricular migration of a stent after endovascular treatment of a superior vena cava syndrome]. / Migration ventriculaire droite d'un stent après traitement endovasculaire d'un syndrome cave supérieur.

The authors report a case of migration of a Palmaz stent used for treatment of a patient with a malignant superior vena caval syndrome. Transoesophageal echocardiography showed the metallic device in the tricuspid subvalvular apparatus. Several attempts to recover the stent percutaneously failed. This case illustrates a rare but serious complication of endovascular stenting: migration of the material. Although it is often possible to reposition the stent by radiological interventional techniques, when the stent is located in the right ventricle, the procedure is more difficult and usually fails. Transoesophageal echocardiography enables accurate localisation of the material with respect to the surrounding cardiac structures, especially the tricuspid valve.