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.

Long COVID in the Belgian Defence forces: prevalence, risk factors and impact on quality of daily functioning.

INTRODUCTION: Long COVID (LC) is a medical condition first described and documented through anecdotes on social media by patients prior to being recognised by WHO as a disease. Although >50 prolonged symptoms of LC have been described, it remains a diagnostic challenge for military providers and therefore threatens operational readiness. METHODS: On 9 September 2021, an online survey was emailed to 2192 Belgian Defence personnel who had previously tested PCR positive for SARS-CoV-2 between 17 August 2020 and 31 May 2021. A total of 718 validated responses were received.Descriptive analyses determined the prevalence of LC and 10 most common symptoms and their duration following infection. In the explanatory analyses, risk factors related to LC were identified. To establish the health-related impact of LC on quality of life (HRQoL), we used the results from the EuroQol 5 Dimension 5 Level questionnaire. RESULTS: The most frequent symptoms that were reported for >3 months were fatigue, lack of energy and breathing difficulties.47.35% of the respondents reported at least one persistent symptom, while 21.87% reported more than 3 symptoms lasting for at least 3 months after the initial COVID-19 infection. Most patients with LC suffered from symptoms of a neuropsychiatric nature (71.76%).LC was significantly associated with obesity; pre-existing respiratory disease and blood or immune disorders. Physical activity of >3 hours per week halved the risk of LC.The total QoL is reduced in patients with LC. Considering the five dimensions of the questionnaire, only the self-care dimension was not influenced by the presence of LC. CONCLUSIONS: Almost half of Belgian Defence personnel developed LC after a confirmed COVID-19 infection, similar to numbers found in the Belgian population. Patients with LC would likely benefit from a multidisciplinary rehabilitation approach that addresses shortness of breath, fatigue and mood disturbance.

Sexual harassment at work within Belgian Defence: a prevalence study.

INTRODUCTION: Sexual harassment (SH) at work can have an impact on the general health and well-being and on the productivity of the employee. To date, the Belgian Armed Forces do not have any accurate data about SH. Therefore, this study assessed the prevalence of SH within Belgian Defence. METHODS: The prevalence of SH and staff mental well-being was investigated in a sample of 399 female soldiers. Using quantitative analysis, we measured the impact on mental well-being and the relation to demographic characteristics. Using a qualitative analysis in a subsample of eight female soldiers, we investigated barriers to reporting SH and the impact on professional performance and psychosocial well-being. RESULTS: The prevalence of non-physical SH is 36.1% over the last 12 months and 64.4% over the course of a career. Physical SH has a prevalence of 16.1% and 43.4%, respectively. Rape prevalence was reported to be 1.4% over the past 12 months, 9% over the course of their career.One in three female soldiers suffer from reduced mental well-being, which was significantly associated with SH. In the interviews, female employees report an impact of SH on professional and personal performance. The willingness to report is low due to misunderstanding, disinformation and psychosocial insecurity. CONCLUSION: High prevalence numbers were found suggesting an important impact on the professional performance and mental well-being of female military personnel. Organisational changes may create more willingness among victims to report incidents to the designated services.

Pathophysiology, diagnosis and treatment of varicoceles: a review.

In this article we reviewed the pathophysiology, diagnosis and treatment of varicoceles. The etiology and pathogenesis of varicoceles cannot be explained by one theory. Valve dysfunction, ontogenetic collateral formation and the nutcracker phenomenon seem to act synergistically. Hyperthermia, elevated hydrostatic pressure and antisperm agents are suggested as possible causes for the pathophysiology how varicoceles induce infertility. However the combination of patient's lifestyle, genetic factors and the consequences of reflux into the pampiniform plexus are believed to contribute to the infertility. Although venography stays the gold standard, the combination of physical examination, color Doppler ultrasound and thermography has the highest sensitivity and specificity to diagnose a varicocele. Regarding infertility, we are still searching for strict criteria or grading, to decide which patients with a varicocele may or may not have benefit from treatment. Treatment of varicoceles can be performed by different open surgical or percutaneous techniques. Treatment of varicoceles for infertility or to prevent infertility remains controversial, because the majority of men with varicoceles are still fertile. At the moment, inguinal or subinguinal microscopic surgery gave the highest pregnancy rates, the lowest recurrence and lowest complication rates. But retrograde superselective glue embolization or sclerosing of the ISV are the best percutaneous alternative and can be performed on an outpatient basis under local anesthesia and with faster return to normal activities than surgery.

Upper gastrointestinal tract bleeding management: Belgian guidelines for adults and children.

UNLABELLED: Upper gastrointestinal bleeding (UGIB) remains a common disease affecting 100 to 170 per 100 000 adults per year and causing thereby a significant burden to healthcare resources. Despite the improvements in the management of this disorder, the associated mortality ranges from 5 to 14%. Since the general management of UGIB is not uniform, the main objective of this work is to provide guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture. METHODS: In the absence of evidence-based recommendations, these guidelines were proposed after expert opinions reconciliation and graded accordingly. They are based on the published literature up to September 2010 and graded according to the class of evidence. RESULTS: The current guidelines for the management of UGIB include recommendations for the diagnostic process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension-induced bleeding.

Angiographic findings and therapeutic embolization of late hemarthrosis after total joint arthroplasty.

OBJECTIVE: The objective of this study was to describe the angiographic findings of late spontaneous hemarthrosis after total joint arthroplasty and to illustrate the therapeutic role of angiography. MATERIALS AND METHODS: A retrospective multicenter study was performed looking for patients who underwent an angiography for spontaneous hemarthrosis occurring at least 1 month after total joint arthroplasty. Eight patients were included, all suffering from spontaneous hemarthrosis. One patient had an additional large extra-articular hematoma. RESULTS: Angiography in eight cases revealed hypertrophic vascular synovium in seven patients with an additional false aneurysm in one patient. Hypervascularization with pooling of contrast spots was seen in one patient. Five patients underwent selective arterial particulate embolization. Three patients were successfully embolized after one session, one was successful after two sessions, and one patient needed surgery after two embolization sessions. CONCLUSION: Angiography for late spontaneous hemarthrosis is very effective to exclude or establish vascular malformations and to establish the diagnosis of hypertrophic vascular synovium. Selective arterial embolization seems to be a good therapeutic option as alternative to open or arthroscopic synovectomy.

Nora's lesion, a distinct radiological entity?

OBJECTIVE: To describe the radiological findings of "Bizarre parosteal osteochondromatous proliferation"(BPOP)-otherwise known as Nora's lesion, to describe the natural evolution of BPOP and to assess radiologically if BPOP is indeed part of a spectrum of reactive lesions including florid reactive periostitis and turret exostosis. DESIGN: Four experienced musculoskeletal radiologists studied plain radiographs and other imaging documents of histologically-proven Nora's lesions, looking for soft-tissue changes, periosteal reaction/calcification and calcified/ossified pseudotumours, and compared those findings with findings on pathology reviewed by a peer group of pathologists. PATIENTS: Twenty-four Nora's lesions originating from a series of 200 consecutive, histologically-verified bone (pseudo)tumours of the hand, seen by the "Netherlands Committee on Bone Tumours" for review and second opinion. RESULTS: Nora's lesions have a recognised presentation on radiographs without specific MR characteristics. Natural evolution could be assessed retrospectively in four cases. Recurrent lesions were seen in seven cases and are difficult to differentiate from primary lesions. CONCLUSIONS: Nora's lesion, defined as a "well-marginated mass of heterotopic mineralization arising from the periosteal aspect of an intact cortex, without medullary changes" has a distinct radiological presentation and is part of a spectrum of reactive lesions which includes florid reactive periostitis and turret exostosis. As it has a distinct radiological appearance, differential diagnosis of malignant lesions such as osteosarcoma and chondrosarcoma should be clear. It does not require immediate biopsy unless the natural evolution is unspecific.

Accuracy of radiography in grading and tissue-specific diagnosis--a study of 200 consecutive bone tumors of the hand.

OBJECTIVE: To determine the usefulness of radiography and magnetic resonance imaging in differentiating benign from malignant bony tumors of the hand and in making a tissue-specific diagnosis. DESIGN: Two hundred consecutive bony tumors of the hand, the details of which originated from a national databank, were studied in a prospective way by radiography (100%) and by MRI (25%). All tumors were graded on a five-point scale, from certainly benign to certainly malignant, using location and morphology as diagnostic parameters. For all tumors a tissue-specific diagnosis was made, by the proposal of three possibilities in decreasing order of probability. Histological diagnosis was made by peer review, according to the WHO classification. RESULTS: By the combining of "certainly" and "probably" benign (grades I and II) and "certainly" and "probably" malignant (grades IV and V), a correct grading was obtained in 165 (82.5%) of the cases (154 of the 173 benign and 11 of the 27 malignant tumors). A correct tissue-specific diagnosis was included in the three proposed differentials in 87.5%. MRI confirmed a correct diagnosis made on radiography in 72% and improved the grading capability by correctly upgrading malignant tumors and downgrading benign tumors in, respectively, 8% and 12%. The capability to obtain a tissue-specific diagnosis improved with change of an incorrect diagnosis on radiography to a correct one on MRI in 12 cases (24%). CONCLUSION: Subjective (semiquantitative) grading on radiography by an expert group proved to be excellent when compared with the results of a quantitative analysis of individual grading parameters. Multiple logistic regression analysis of these parameters resulted in a grading formula containing only six variables. The additional value of MRI in grading was amply demonstrated. Already high accuracy of radiography, in making a tissue-specific diagnosis, improved substantially after the performance of MRI.

Is there an evolution in the epidemiology and follow-up of carbon monoxide poisoning victims?

A retrospective study was conducted to investigate for potential changes in the epidemiology of acute carbon monoxide (CO) poisoning and to evaluate the recommendations within the emergency department (ED) on therapy and neurological and social follow-up of these patients. One hundred and sixty-seven patients with a non-intentional CO poisoning in the time period from 1995 to 1997 were reviewed and compared with data of a similar patient population between 1988 and 1990. Both patient groups were matched for age, sex and comorbidity. Comparing the epidemiological data of the two groups, three main evolutions were observed: (1) there is a global reduction in ED admissions for CO poisoning; (2) the number of young victims has a tendency to decrease; (3) the most common CO source has become an insufficiently functioning stove instead of a defective gas water heater. Regarding treatment and follow-up strategies three conclusions could be drawn: (1) the recommendations for hyperbaric-oxygen therapy were strictly followed; (2) the neurological follow-up was poor and has to be ameliorated and revisited; (3) the systematic follow-up by the social worker on the other hand resulted in immediate actions to prevent a second CO poisoning. This recently elaborated protocol for social evaluation emphasizes the important function of the social worker in the ED and the importance of transmural follow-up organized by the ED.

Impaired microcirculation in heart failure.

The aim of the present study was to examine the nailfold capillary morphology and dynamics in treated chronic heart failure (CHF) in relation to parameters of left ventricular structure and function. Twenty patients with CHF class II according to the New York Heart Association underwent a capillaroscopic examination at the finger nailfold using a computerized videophotometric system (Capiflow) at rest and after 1 min arterial occlusion. Study parameters ere number, length and diameter of the capillaries as well as capillary blood velocity (CBV). Further experiments included echocardiography and determination of left ventricular ejection fraction by Tc scintigraphy. Nailfold capillaries in established CHF are enlarged and the CBV is dramatically decreased. The reactive hyperemic response to 1 min arterial occlusion is attenuated. CBV correlates positively with left ventricular ejection fraction (r = 0.61, p = 0.01) and inversely with left ventricular end-diastolic (r = -0.56, p = 0.04) and end-systolic (r = -0.69, p = 0.01) diameters. The time-to-peak flow after 1 min arterial occlusion is positively related (r = 0.68, p < 0.05) to the duration of CHF. Our data indicate that finger microcirculation in CHF deteriorates as a function of the severity and duration of heart failure.

Superior vena cava syndrome after implantation of a transvenous cardioverter defibrillator.

Superior vena cava syndrome is a rare, but nevertheless well known complication of permanent pacemaker implantation. Nowadays cardioverter defibrillators are also routinely implanted transvenously. A superior vena cava syndrome occurred in a 48-year-old female 2 years after implantation of cardioverter defibrillator. The clinical problem, in the presence of a predisposing thrombophilic condition (circulating lupus anticoagulant), resolved only partially after treatment with thrombolytics and oral anticoagulation. This syndrome should be recognized as a possible important complication of defibrillator therapy and requires lifelong anticoagulation.

Upper airway obstruction due to inoperable intrathoracic goitre treated by tracheal endoprosthesis.

Thyroidectomy is the treatment of choice in patients with thyroid enlargement complicated by compression or displacement of the trachea because of the risk of complete airway obstruction due to sudden enlargement of the goitre by, for example, haemorrhage. In patients who are medically inoperable an endoscopically inserted tracheal endoprosthesis may provide longstanding airway patency, as reported here.

A simplified insertion technique for tracheobronchial silicone stents.

In many patients with central airway obstruction due to extrinsic compression or malacia, insertion of tracheobronchial stents can provide effective and permanent relief. Of the various types of prostheses described, the silicone Dumon-Artemis stents (Medicore, Brussels, Belgium) are probably the most efficient. The use of an elegant and safe specially designed stent introducer system combined with a special bronchoscope is proposed for insertion by Dumon. This combined stent insertion system, however, is relatively expensive and cumbersome, especially for centers where relatively limited numbers of patients are treated. We propose an alternative, simplified insertion technique of silicone Dumon-Artemis stents, which was proven safe and efficient in our series of patients.

Successful management of recurrent pneumothorax in cystic fibrosis by localized apical thoracoscopic talc poudrage.

Thoracoscopic talc poudrage of the entire pleural surface constitutes successful treatment of recurrent pneumothorax in cystic fibrosis (CF); however, subsequent lung transplantation is seriously jeopardized due to the development of extensive pleural adhesions. We describe a 27-year-old patient with CF with recurrent right-sided pneumothorax, refractory to chest tube drainage and to chemical (tetracycline) pleurodesis, who was successfully treated with a localized, apical thoracoscopic talc poudrage, thereby preserving the possibility of subsequent lung transplantation.

Prosthetic valve endocarditis due to Listeria monocytogenes. A case report with review of the literature.

We report the case of a 71-year-old man with a prosthetic aortic valve endocarditis caused by Listeria monocytogenes. He was successfully treated with a combination of ampicillin and amikacin, and valve replacement surgery. This case and previously reported cases are discussed.

Long-term functional results of the non-surgical treatment of common bacterial infections of joints.

Thirty patients with acute bacterial infection of a peripheral joint were treated with intravenous antibiotics, daily closed needle aspiration and early mobilization therapy. Joint mobility, expressed as a percentage of normal mobility, was evaluated at the end of the reconvalescence period and again after 42 to 65 months (mean: 50 months). The functional outcome was excellent and joint mobility normal in 2/3 of the cases as revealed by the short- and long-term evaluation results. Factors that affected joint mobility were: delayed treatment, joint disorders prior to treatment, and ease of access to the joint for needle aspiration. Poor results were found in the presence of hip infections. In the long term, deterioration of joint mobility can occur in the same aggravating conditions. Treatment of septic arthritis with daily needle aspiration and early mobilization gave very good functional results.

Levamisole as basic treatment of rheumatoid arthritis: longterm evaluation.

We evaluated longterm levamisole treatment of 201 rheumatoid patients. Fifty-nine patients in their 1st yr of treatment were not analyzed; of the remaining 142, 69 (49%) still took levamisole with benefit. Levamisole was stopped in 32 patients (22%) for inefficacy and for reversible adverse reactions in 37 (26%). Leukotoxic side-effects were the commonest cause of withdrawal (23 patients = 16%). Since June 1977, we administer levamisole on a 1 d/wk schedule (150 mg), with determination of white blood cells 10 h after intake to detect high-risk patients for agranulocytosis. With disease exacerbation during treatment or lack of response after 6 months, the drug is given on a 2nd non-consecutive day. Since June 1977, cases of agranulocytosis have not been observed. Allergic vasculitis did not occur with a 1 d/wk schedule. The absence of nephrotoxicity and hepatotoxicity is stressed. Only 4 patients (3%) were lost to follow-up. Comparison is made with longterm use of gold and D-penicillamine. We conclude that levamisole is a useful slow acting antirheumatic drug.