14 research outputs found
VI2TA2 S2C2ORE: a new score system for in hospital mortality in acute aortic dissections
No full textAortic Dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study is to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections
Towards an entirely endovascular aortic world: an update of techniques and outcomes for endovascular and open treatment of type I, II, and III endoleaks
No full textEndovascular aneurysm repair (EVAR) is largely the most adopted strategy for aneurysmal disease of the aorta. Nevertheless, the high incidence of reintervention makes it difficult to identify EVAR as a definitive solution; in particular, the most frequent indication of reintervention is endoleak, which is defined as persistent flow into the aneurysmal sac from different sources. Several treatment strategies are described. A contemporary literature search was performed with the intent of describing techniques and outcomes of endovascular and open strategies to type I, II, and III endoleak. Described techniques and outcomes were organized by indication (type I, II, and III endoleak) and by type of approach (endovascular, open, and laparoscopic) to give an overview of the current status of the treatment for the three most frequent types of endoleak. Several endovascular means are described in the literature for the treatment of endoleak
"Over-SIRIX". A new method for sizing aortic endografts in combination with the chimney grafts. early experience with aortic arch disease
No full textBACKGROUND:
Large gutters after chimney procedures are one of the main causes of type I endoleak (EL-I). This study aims to evaluate a new tailored planning named "Over-SIRIX," based on Osirix Imaging Software, to choose the correct main graft oversizing in order to minimize EL-I incidence.
METHODS:
From 2008 to 2015, 34 patients were treated with parallel grafts for aortic arch diseases at our institution. The study included 22 patients with single stent and antegrade flow configuration; they were divided into 2 groups (PRE- and POST-"Over-SIRIX"). "Over-SIRIX" was carried out in the retrospective group (PRE-"Over-SIRIX"), and it was used to plan the endovascular procedure in the prospective group (POST-"Over-SIRIX"). Through the multiplanar reconstruction (MPR) of the preoperative computed tomography angiography (CTA), the proximal neck of the chimney grafts was studied. Stent and endograft configurations were drawn in order to minimize the "gutters." To obtain the ideal main graft sizing (I-Size), a formula was used by adding the custom sizing (C-Size) to the disease oversizing (D-Over). The same MPR imaging was evaluated on postoperative CTA to study gutters area and presence of EL-I.
RESULTS:
The mean I-Size was 41.67 mm that was equivalent to an ideal oversizing of 19.3% (range 10-28%). The gutters area decreased from 7.3 to 1.7 mm2 (PRE/POST) and EL-I rate from 28.5% to 0% (PRE/POST). Gutters area bigger than 7.5 mm2 and planning made without "Over-SIRIX" were significantly associated (P < 0.05) to EL-I.
CONCLUSIONS:
"Over-SIRIX" appears to be a feasible method to customize planning during chimney technique, reducing the risk of EL-I which is significantly related to the presence and size of the gutters
Surgical treatment of thoracic outlet syndrome: immediate and mid-term results
No full textIntroduction: We report the results from a consecutive series of patients treated by
scalenectomy or cervical rib resection for clearly symptomatic or paucisymptomatic
thoracic outlet syndrome (TOS) over a 6-year period.
Material and methods: From September 1999 to August 2005, 14 surgical
decompressions were performed in 12 patients with unremitting signs and
symptoms of nerve or vascular compression at the thoracic outlet. The symptoms
of TOS were due to involvement of the brachial plexus in 8 cases (57.1%). A sign
of vascular obstruction could be detected in 10 cases (71.4%): in 6 cases (42.8%)
the presentation was predominantly arterial (arm claudication, coldness, Raynaud’s
phenomenon and distal embolisation) and in 4 cases (28.5%) was related to vein
compression with congestion and swelling of the affected arm or vein thrombosis.
Two patients presented as emergencies with critical upper limb ischaemia or distal
vessel embolisation.
Results: The median follow-up period was 28.2 months (range 8-78 months).
Results were evaluated in terms of technical success, lack of complications
(temporary or permanent plexus injury, temporary or permanent phrenic palsy),
relief of symptoms. Outcome data were divided into immediate/perioperative
and mid-term results. Perioperative results: There was no operative mortality.
Technical success was achieved in all patients in excision of the fibrous band
with scalenectomy and in cervical rib excision. Mid-term results: In 4 patients
with venous symptoms complete relief was achieved in 75%. In all patients who
experienced arterial complications we registered complete relief. In patients with
neurological presentation we detected complete relief in 5 (62.5%), relief of some
symptoms in 2 (25%) and no improvement in 1 (12.5%).
Conclusions: Scalenectomy performed by a standard supraclavicular approach seems
to allow relief in the majority of patients with symptoms of neurological, arterial or
venous compression at the thoracic outlet. Nevertheless, we emphasize the importance
of an objective method of evaluation and the necessity of a prolonged follow-up.
Key words: thoracic outlet syndrome, scalenectomy, cervical rib resection
IL TRATTAMENTO ENDOVASCOLARE DELL’ANEURISMA DELL’AORTA ADDOMINALE: NOSTRA ESPERIENZA ENDOVASCULAR TREATMENT OF ABDOMINAL AORTIC ANEURISMS: OUR EXPERIENCE
No full textBackground. This report prospectively analyzes collected data of endovascular treatment
of abdominal aortic aneurysms in 114 patients selected to receive stent implantation based on
anatomic criteria and surgical risk. Methods. From December 2002 to May 2006, 114 patients with
abdominal aortic aneurism receive endovascular treatment. 108 were men (94,7%) and 6 female; age
range was 57-86 years with mean age of 73.3. The mean maximum diameter of the AAA was 5.71
cm (range 3.7- 13.0). Three different types of stents were used most of which were bifurcated in design
(97,3%). Endograft used were: Excluder, Talent; Zenith-Cook. Results. No perioperative mortality
was observed; 5 (4,3%) type I and 11 (9,6%) type II endoleak were detected; Iliac extension with
exclusion of the internal iliac artery was required in 27 cases. We observed 2 right branch, 2 iliac lesions,
2 ematoma and 1 distal vessels embolization surgically treated Mean follow-up period was
18,6 months. 17 patients died during follow-up. 11 endoleak were discovered during follow-up and in
3 cases thrombosis of a branch occurred. Mean aneurysm diameter, neck diameter, iliac or hypogastric
diameter or the clinical characteristics showed no statistical significant differences among the
three group (on the results). In each group influence of aneurysm and neck morphology and diameter
on type I or II endoleak was analyzed but no statistical significant differences were detected
among the three groups except for type-II endoleak in the Talent group that was registered in 100%
of no mural thrombus – aneurysms (p<0,05). Conclusions. Together with aneurysm sac growth andbranch vessels’ patency, structural failures continues to be a challenging problem. As long as no solution
will be find out for them endovascular aneurysm repair will remain an imperfect long-term
treatment and continued follow-up will be mandatory.
Key words: Aortic aneurysm, Aortic surgery, Endovascular treatment
A discussion of stock market speculation by Pierre-Joseph Proudhon
No full textThe object of this contribution is to present the ideas behind the thinking of the French economist Pierre-Joseph Proudhon (1809-1865) in relation to the causes and effects of Stock market speculation. It is based upon the works of this author but particularly on his “Manuel du spéculateur à la Bourse” (Stock Market Speculator Manual) edited in 1857 in Paris. Compared to the markets of today, however, the stock market described by Proudhon appears embryonic. Nevertheless it represents the location for transactions in financial assets, commodities, precious metals and even some transactions involving options. This contribution is organised in the following manner - the first section is devoted to the development of Proudhon's thought in relation to speculation. It is divided into two parts. The first part is dedicated to Pierre-Joseph Proudhon's definitions of stock market speculation or gambling with shares that for him served no purpose either from a human or economic perspective and was therefore condemnable and to be contrasted with entrepreneurial speculation that, even though it is a highly-risky activity, involves the spirit of enterprise and provides the lifeblood of economic growth. The second part allows us to present Pierre-Joseph Proudhon's propositions in relation to restricting the speculation that he considers obnoxious. The second section has two objectives: one part places in perspective the views of Proudhon and the characteristics of stock market activity under the Second Empire whilst the other part examines current-day aspects of the characteristics evoked by Proudhon. We are interested especially in the question of the regulation and that of the relevance today of certain accounting practices.Proudhon ; speculation ; stock market ; regulation of financial markets
Distal vertebral artery reconstruction: Long-term outcome
No full textAbstractPurpose: The purpose of this article was to report our long-term results of distal vertebral artery (DVA) reconstruction. Method: From 1978 to 2001 we performed 352 DVA reconstructions on 323 patients (177 men, 148 women; mean age, 60.0 ± 12.1 years). Symptoms of vertebrobasilar insufficiency were present in 332 cases (94.3%). Bypass grafting using mostly saphenous vein graft was performed in 240 cases (68.2%). In 102 cases (29.0%) the DVA was transposed into the internal carotid artery (ICA). Other techniques were used in 10 cases. Results: Stroke caused all 7 deaths (2.0%) in the early postoperative period. There were 5 nonfatal strokes (1.4%). Strokes were hemispheric in 7 cases (6 ipsilateral, 1 contralateral) and vertebrobasilar in 5 cases. There were 6 strokes (2.3%) in the subgroup of 264 isolated DVA reconstruction and 6 strokes (6.8%) in the subgroup of 88 procedures involving combined ICA and DVA reconstruction (P < .04). Temporary paralysis of the spinal accessory nerve occurred in 26 cases (7.4%). Intraoperative or early postoperative angiography findings were available in 341 of 345 cases (98.8%). Early postoperative occlusion occurred after 25 procedures (7.1%). Complete clinical follow-up was available for 313 (99.1%) of the postoperative survivors. Mean duration of follow-up was 99.5 ± 62.5 months. Assessment of late patency was performed in 343 (99.4%) of 345 cases by angiography (21.2%) or duplex scanning (78.8%). A total of 65 (23.7%) patients died during follow-up. No deaths resulted from vertebrobasilar or hemispheric stroke. Cumulative Kaplan-Meier survival rate was 89.0% ± 3.9% at 5 years and 75.4% ± 7.1% at 10 years. Significant vertebrobasilar symptom-free rate was 94.0% ± 3.5% at 5 years and 92.8% ± 3.8% at 10 years. Primary patency rate was 89.3% ± 3.6% at 5 years and 88.1% ± 4.0% at 10 years. Conclusions: This study clearly establishes the excellent long-term results of DVA reconstruction for the treatment of extracranial lesions of the vertebral artery. However, every effort sould be made to reduce the rate of early postoperative occlusions. The subgroup of patients involving combined ICA and DVA reconstruction remains at high risk of postoperative stroke. (J Vasc Surg 2002;36:549-54.
La comptabilité en IFRS et ses maux : quels mots pour le dire ?
No full textInternational audienceTeaching accounting is a great challenge in the way that it’s need to articulate technical knowledge with understanding of its social and economic issues. The international accounting standards have increased this difficulty. They made a break, which could be used, anyway, to try to overcome the gap existing between these standards and our political, economic and cultural system. Our study of international standards could be seen as an exegesis. We have drawn analytical tools to a literal but more for a more comprehensive approach. This one takes into account the author, his historical and social context, his intentions and goals, but also the readers (users, teachers and students). Thanks to this work we offer some thoughts on accounting education.La transmission de savoirs techniques articulés avec l’explication et la compréhension de ses enjeux économiques et sociaux constitue une difficulté importante de l’enseignement de la comptabilité. L’introduction des normes comptables internationales d’inspiration anglo-saxonne a renforcé cette difficulté ; ces dernières constituent une rupture qui invite à s’en emparer et à chercher à pallier le hiatus existant entre les intentions portées par ce corpus normatif et notre système politique, économique et culturel. Notre travail d’étude des normes s’est alors apparenté à une forme d’exégèse. Nous avons puisé, dans cette approche, des outils d’analyse qui permettent à la fois une analyse littérale et une démarche plus globale, situant l’auteur dans son contexte historico-social (IASB, institution rassemblant les rédacteurs des normes), prenant en compte ses intentions et ses objectifs, et intégrant les lecteurs (utilisateurs, enseignants et étudiants). Ce travail nous a également permis de proposer quelques réflexions sur les possibilités d’évolution de l’enseignement de la comptabilité
La comptabilité en IFRS et ses maux : quels mots pour le dire ?
No full textInternational audienceTeaching accounting is a great challenge in the way that it’s need to articulate technical knowledge with understanding of its social and economic issues. The international accounting standards have increased this difficulty. They made a break, which could be used, anyway, to try to overcome the gap existing between these standards and our political, economic and cultural system. Our study of international standards could be seen as an exegesis. We have drawn analytical tools to a literal but more for a more comprehensive approach. This one takes into account the author, his historical and social context, his intentions and goals, but also the readers (users, teachers and students). Thanks to this work we offer some thoughts on accounting education.La transmission de savoirs techniques articulés avec l’explication et la compréhension de ses enjeux économiques et sociaux constitue une difficulté importante de l’enseignement de la comptabilité. L’introduction des normes comptables internationales d’inspiration anglo-saxonne a renforcé cette difficulté ; ces dernières constituent une rupture qui invite à s’en emparer et à chercher à pallier le hiatus existant entre les intentions portées par ce corpus normatif et notre système politique, économique et culturel. Notre travail d’étude des normes s’est alors apparenté à une forme d’exégèse. Nous avons puisé, dans cette approche, des outils d’analyse qui permettent à la fois une analyse littérale et une démarche plus globale, situant l’auteur dans son contexte historico-social (IASB, institution rassemblant les rédacteurs des normes), prenant en compte ses intentions et ses objectifs, et intégrant les lecteurs (utilisateurs, enseignants et étudiants). Ce travail nous a également permis de proposer quelques réflexions sur les possibilités d’évolution de l’enseignement de la comptabilité
1-Year results from a prospective experience on CAS using the CGuard stent system: The IRONGUARD 2 study
No full textObjectives: The aim of this study was to evaluate the 1-year safety and efficacy of a dual-layered stent (DLS) for carotid artery stenting (CAS) in a multicenter registry.
Background: DLS have been proved to be safe and efficient during short-term follow-up. Recent data have raised the concern that the benefit of CAS performed with using a DLS may be hampered by a higher restenosis rate at 1 year.
Methods: From January 2017 to June 2019, a physician-initiated, prospective, multispecialty registry enrolled 733 consecutive patients undergoing CAS using the CGuard embolic prevention system at 20 centers. The primary endpoint was the occurrence of death and stroke at 1 year. Secondary endpoints were 1-year rates of transient ischemic attack, acute myocardial infarction, internal carotid artery (ICA) restenosis, in-stent thrombosis, and external carotid artery occlusion.
Results: At 1 year, follow-up was available in 726 patients (99.04%). Beyond 30 days postprocedure, 1 minor stroke (0.13%), four transient ischemic attacks (0.55%), 2 fatal acute myocardial infarctions (0.27%), and 6 noncardiac deaths (1.10%) occurred. On duplex ultrasound examination, ICA restenosis was found in 6 patients (0.82%): 2 total occlusions and 4 in-stent restenoses. No predictors of target ICA restenosis and/or occlusion could be detected, and dual-antiplatelet therapy duration (90 days vs 30 days) was not found to be related to major adverse cardiovascular event or restenosis occurrence.
Conclusions: This real-world registry suggests that DLS use in clinical practice is safe and associated with minimal occurrence of adverse neurologic events up to 12-month follow-up
