Swiss School of Archaeology in Greece
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Early transition from short-term romosozumab to antiresorptive therapies: analysis of 26 cases.
No full textThis multicentre, retrospective case series analysed bone mineral density (BMD) changes in 26 patients who switched early from romosozumab (3-10 months) to antiresorptives. BMD gains over 12 months were similar to those in patients (n = 99) completing the full 12-month course.Romosozumab is typically administered for a duration of 12 months before transitioning to antiresorptive therapies. This study analysed the bone mineral density (BMD) changes of patients who were prematurely switched to an antiresorptive regimen.This multicentre, retrospective case series investigated the BMD response to romosozumab administered for 3 to 10 months, followed by subsequent antiresorptive therapy, across four bone centres in Switzerland. BMD measurements at the lumbar spine, total hip and femoral neck were conducted at the initiation of romosozumab and again 12 months later. The study compared the BMD changes in patients who received short-term romosozumab with those in a cohort of patients who completed the full 12-month course.Twenty-six patients (25 postmenopausal women and one man, median age 73 years [interquartile range: 65, 81]) were enrolled from February 2022 to December 2024. They received a median of six romosozumab injections (range: 3 to 10) and were prematurely switched to antiresorptives (14 to denosumab, 11 to zoledronate and one to alendronate) due to possible side effects or adverse events. Over 12 months, BMD increased by 13.5% [8.6, 16.6] at the lumbar spine, 2.9% [0.3, 7.3] at the total hip and 3.2% [0.4, 7.8] at the femoral neck, without significant differences compared with the cohort of 99 patients who received 12 months of romosozumab therapy. In both the short- and full-duration romosozumab treatment groups, significantly lower BMD responses were observed in patients who were pretreated with antiresorptives compared with those who were treatment naïve.In patients who underwent an early switch from romosozumab to antiresorptive therapy, BMD responses during the first year were similar to those in patients who completed the full 12-month romosozumab treatment. However, the subsequent changes in BMD, when all patients are receiving antiresorptive therapy, remain to be determined.© 2025. The Author(s)
Trapeziometacarpal joint replacement: An economical comparison between WALANT and plexus block anesthesia.
No full textThe study "Cost and Efficiency Benefits of WALANT for Trapeziometacarpal Joint Implantation Arthroplasty" aimed to compare the cost-effectiveness and efficiency of the "wide awake local anesthesia, no tourniquet" (WALANT) technique to the traditional axillary block (AB) anesthesia in trapeziometacarpal (TMC) joint arthroplasty.In this monocentric retrospective study, 39 patients who underwent TMC joint arthroplasty were divided into two groups: 10 with WALANT and 29 with AB. The results showed that WALANT led to an 18.7% reduction in costs compared to AB, with total operating room (OR) time being 5 minutes shorter for the WALANT group. Despite similar surgical times, the "all-but-surgery" time (OR time excluding surgery) was reduced for WALANT, contributing to these savings. Patients in the WALANT group reported minimal pain during surgery and low postoperative pain, with opioid use discontinued by day 3.The study concluded that WALANT is an efficient, cost-effective alternative for TMC joint arthroplasty, providing similar patient experience in terms of pain and recovery while optimizing OR time and reducing costs. However, it noted limitations such as a small sample size and the non-randomized nature of anesthesia choice. Further studies are recommended to confirm these findings
Ethylene-vinyl alcohol copolymer-based non-adhesive liquid embolic agents in interventional radiology: A paradigm shift?
No full textTelangiectatic Capillaries in Retinal Vein Occlusion: Incidence, Topography, and Risk Factors.
No full textTo investigate the incidence, timing, dimensional features, and spatial characteristics of telangiectatic capillaries (TelCaps) in retinal vein occlusion (RVO) patients treated with anti-VEGF monotherapy.
Prospective nonconcurrent cohort study.
One hundred thirty-eight eyes of 138 patients with treatment-naive RVO treated with anti-VEGF monotherapy for a minimum of 24 months.
Telangiectatic capillaries were identified using multimodal imaging, including indocyanine green angiography (ICGA), OCT, and color fundus photography. Recurrence of venous occlusive events was defined by new onset of retinal hemorrhages accompanied by worsening of macular edema. Cox regression modeling was used to assess risk factors for TelCap development.
Telangiectatic capillaries' incidence, dimensional features, spatial distribution, and association with RVO recurrence events.
Over 4.4 ± 2.6 years of follow-up, TelCaps developed in 15/138 eyes (10.9%) after 26 ± 16 months. Telangiectatic capillaries in hemispheric and central RVO showed larger diameters compared with branch RVO (277 ± 44 μm vs. 196 ± 43 μm, P = 0.005) and preferential localization along the temporal horizontal raphe (y-axis coordinates: 0.4 ± 0.6 mm vs. 0.9 ± 0.7 mm, P = 0.017). The recurrence of RVO during follow-up was significantly associated with TelCap development (hazard ratio = 8.74, 95% confidence limit = 2.92-26.2, P < 0.001). At 5-year follow-up, the risk of developing TelCaps was ∼9% in patients without recurrence and ∼55% in those patients with recurrence.
Telangiectatic capillaries occur in approximately 10% of RVO cases undergoing intravitreal anti-VEGF monotherapy, with distinct characteristics based on RVO subtype. The strong association with disease recurrence suggests episodes of increased venous obstruction contribute to TelCap formation. Extended follow-up and vigilant screening are recommended; when TelCaps are suspected, ICGA can confirm the diagnosis and guide adjunctive targeted treatment.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article
Suivi des patients opérés par la technique STABILISE pour une dissection aortique de type B
No full textIntroduction
Au cours de ces dernières années, la prise en charge endovasculaire des dissections aortiques de type B a connu des évolutions majeures. La technique STABILISE (Stent-Assisted Balloon- Induced Intimal Disruption and Relamination in Aortic Dissection Repair) représente l’évolution la plus récente du traitement endovasculaire des dissections aortiques de type B. Cette procédure vise à restaurer l’intégrité anatomique et fonctionnelle de l’aorte, en promouvant le remodelage aortique, en éliminant la perfusion de la fausse lumière, en améliorant la malperfusion, et en réduisant ainsi le risque de complications. Le but de cette étude est d’analyser les résultats de notre série de patients traités par cette technique au CHUV dans le service de chirurgie vasculaire.
Matériel et Méthode
Il s'agit d'une étude observationnelle, rétrospective et monocentrique. Le suivi post-opératoire a été réalisé par consultations médicales et angioscanners de l’aorte thoraco-abdominale à 1 mois, 6 mois et 1 an après la procédure. Le critère de jugement principal est d’évaluer le succès clinique à 30 jours après la procédure STABILISE. Les critères de jugement secondaires sont d’évaluer le taux de mortalité à 6 et 12 mois, la persistance de perfusion de la fausse lumière, l’augmentation du diamètre aortique suggérant une évolution anévrismale, les réinterventions liées à l’aorte ou sur les vaisseaux cibles, et le taux d’ischémie médullaire.
Résultats
Le traitement STABILISE, étant la prise en charge standardisée des dissections aortiques aiguës ou subaiguës et très rarement chroniques de type B, au sein du service de chirurgie vasculaire du CHUV, 25 patients ont été traités entre novembre 2019 et février 2024, dont 23 ont donné leur consentement. Le taux de succès clinique à 30 jours est de 91% avec un succès technique de 100% et une absence de décès post-opératoire. Les patients ont principalement été opérés en phase aiguë et subaiguë, pour une malperfusion ou une évolution anévrismale de la dissection. Près de deux tiers des patients ont eu l’implantation de leur endoprothèse proximalement à l’artère sous-clavière, et tous ont bénéficié d’une revascularisation des troncs supra-aortiques couverts, dont la majorité par voie chirurgicale. Un total de 17 stents a été implanté chez 14 patients, en procédure adjuvante afin d’obtenir une bonne perméabilité des vaisseaux viscéraux et rénaux. Aucun patient n’a présenté d’ischémie médullaire. Lors du suivi jusqu’à 1 an, 18% des patients ont nécessité une réintervention liée à l’aorte, principalement pour une dilatation anévrismale en dehors de la zone couverte. Aucun décès, aucune autre réintervention et aucune nouvelle complication médicale n’ont été observés. À 1 an, les diamètres aortiques restent stables, sans signe de dilatation anévrismale, mais uniquement 48% des cas présentent une thrombose de la fausse lumière.
Conclusion
La technique STABILISE montre des résultats prometteurs dans le traitement de la dissection aortique de type B en termes d’e`icacité et de sécurité, mais des études supplémentaires sont nécessaires pour confirmer ces résultats
Clinical and laboratory risk factors for sickle cell retinopathy and maculopathy: a scoping review of the current evidence.
No full textSickle cell retinopathy (SCR) is a complication of sickle cell disease (SCD) and can drastically impair visual acuity. Screening for SCR is, therefore, recommended, but evidence for optimal screening frequency on an individual level is lacking. This scoping review mapped the current evidence on risk factors for SCR and sickle cell maculopathy (SCM). A literature search (in Medline [Ovid]), Embase [Ovid]), and Scopus) resulted in 67 included articles which covered demographic risk factors, genetic risk factors, systemic therapy, correlations with other forms of SCD-related organ damage, and hematologic risk factors. SCR risk factors include older age, male sex, HbSC genotype, hemolysis, and HbF% 15%) to ensure comprehensive yet proportionate ophthalmic care. However, future studies are needed on the role of interventions for SCR and the long-term consequences of SCM in order to evaluate and define appropriate screening schedules
Neurological Outcome of Spinal Hemangioblastomas: An International Observational Multicenter Study About 35 Surgical Cases.
No full textHemangioblastomas (HBs) are benign, highly vascular tumors that can be found intracranially or in the spinal region, representing around 2-15% of primary intramedullary tumors. They can occur sporadically or in association with Von Hipple-Lindau (VHL) disease. Despite recent of advancement of nonsurgical treatments, complete surgical resection remains the gold standard of care for the spinal HBs.
We conducted an international multicenter retrospective analysis of adult patients surgically treated for spinal HBs in four European referral centers between January 2000 and September 2024, with a minimum post-operative follow-up duration of 6 months. Patients' sex and age at surgical intervention, clinical presentation, and duration symptoms prior to clinical diagnosis were identified. The pre- and post-operative neurological status at 1 and 6 months and at the last visit was assessed using the modified McCormick score (MCS). The extent of surgical resection was divided into gross total resection (GTR) and subtotal resection (STR). Finally, post-operative complications were inspected as well, namely cerebrospinal fluid leaks, infections, hemorrhages and post-operative spinal stability.
A total of 35 patients were included in the cohort, with an age median of 52 years (34.5-60) and a slight male predominance (21/35, i.e., 60%). The median follow-up period was 37.5 months (12-75). More than half were located in the cervical region, making it the most common (54.3%). Syrinxes were observed in 23 cases (72%), and HBs were more commonly intramedullary (80%). GTR was achievable in around 88% of cases. Post-operative complications were observed in nine patients (25.7%). Nearly half of patients were discharged into rehabilitations centers (48.5%). Tumor recurrence was seen in 10.3% only. At the last follow-up, an excellent overall post-operative neurological status (positive ∆ McCormick) was observed in most of patients (88%) and was found to be associated with a relatively younger age group. Tumor location and presence of syrinxes did not show any statistical significance regarding clinical outcome. In patients having benefited from intra-operative monitoring, only D-wave changes showed statistical significance regarding post-operative outcome (p < 0.05).
A large majority of patients operated for a spinal HB demonstrated favorable outcome after surgery, with unchanged or improved neurological status. Advanced age could have an impact on the post-operative neurological outcome. Other factors such as tumor size, location, and the presence of syrinx did not seem to significantly impact the neurological outcome. Finally, the surgery of these vascular lesions with no possibility of debulking or piece-meal removal and requiring "en bloc" resection is technically demanding and should be performed by experienced teams in spine and spinal cord surgery only
Intracardiac or transesophageal echocardiography for left atrial appendage occlusion: an updated systematic review and meta-analysis.
No full textIntracardiac echocardiography (ICE) appears to be a potential alternative for percutaneous left atrial appendage occlusion (LAAO) to transesophageal echocardiography (TEE). Thus, a meta-analysis was performed comparing ICE vs. TEE for LAAO guidance.
A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023.
18 studies (124,230 patients) were included. Technical success was higher in ICE- compared to TEE-guidance (OR: 1.36, 95% CI 1.14 to 1.63, p = 0.006) and fewer devices employed (SMD: -0.22, 95% CI -0.43 to -0.01, p = 0.04, I2 = 62%). ICE guidance related with more pericardial effusion/tamponade and iatrogenic residual shunts (logRR: 0.62, 95% CI 0.36 to 0.89, p < 0.001 and RR: 1.53, 95% CI 1.12 to 2.09, p = 0.02, I2 = 1%, respectively). More vascular complications were noted in ICE group (logRR: 0.45, 95% CI 0.11 to 0.78, p = 0.009).
ICE-guided imaging is an effective alternative to TEE in LAAO, as it shows better efficacy than TEE, considering technical success. However, the higher rates of adverse events should be carefully considered