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Calame P, Rostam M, d'Alteroche L, Malakhia A, Cervoni JP, Weil D, Martino VD, Sutter O, Greget M, Risson JR, Vionnet M, Bouvier A, Mokrane FZ, Ghelfi J, Papadopoulos P, Sangel C, Rodes A, Goupil J, Delabrousse E, Douane F, Loffroy R, Hebert T, Boizet A, Guerrab A, Raynaud N, Carbillet PQ, Dumas V, Velasco S, Lapuyade B, Pey MA, Boatta E, De Marini P, Cœur J, Verdot P. Left gastric vein embolization during TIPS placement for acute variceal bleeding has no effect on bleeding recurrence: Results of a multicenter study. Diagn Interv Imaging 2023; 104:248-257. [PMID: 36740536 DOI: 10.1016/j.diii.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether concomitant left gastric vein embolization (LGVE) during transjugular intrahepatic portosystemic shunt (TIPS) for acute variceal hemorrhage could reduce the risk of bleeding recurrence. MATERIAL AND METHOD A national multicenter observational study was conducted in 14 centers between January 2019 and December 2020. All cirrhotic patients who underwent TIPS placement for acute variceal bleeding were included. During TIPS procedure, size of left gastric vein (LGV), performance of LGVE, material used for LGVE and portosystemic pressure gradient (PPG) before and after TIPS placement were collected. A propensity score for the occurrence of LGVE was calculated to assess effect of LGVE on rebleeding recurrence at six weeks and one year. RESULTS A total of 356 patients were included (mean age 57.3 ± 10.8 [standard deviation] years; 283/356 [79%] men). Median follow-up was 11.2 months [interquartile range: 1.2, 13.3]. The main indication for TIPS was pre-emptive TIPS (162/356; 46%), rebleeding despite secondary prophylaxis (105/356; 29%), and salvage TIPS (89/356; 25%). Overall, 128/356 (36%) patients underwent LGVE during TIPS procedure. At six weeks and one year, rebleeding-free survival did not differ significantly between patients who underwent LGVE and those who did not (6/128 [5%] vs. 15/228 [7%] at six weeks, and 11/128 [5%] vs. 22/228 [7%] at one year, P = 0.622 and P = 0.889 respectively). A total of 55 pairs of patients were retained after propensity score matching. In patients without LGVE, the rebleeding rate was not different from those with LGVE (3/55 [5%] vs. 4/55 [7%], P > 0.99, and 5/55 [9%] vs. 6/55[11%], P > 0.99, at six weeks and one year respectively). Multivariable analysis identified PPG after TIPS placement as the only predictor of bleeding recurrence (hazard ratio = 1.09; 95% confidence interval: 1.02-1.18; P = 0.012). CONCLUSION In this multicenter national real-life study, we did not observe any benefit of concomitant LGVE during TIPS placement for acute variceal bleeding on bleeding recurrence rate.
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Affiliation(s)
- Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Mathieu Rostam
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | | | - Alexandre Malakhia
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
| | - Jean-Paul Cervoni
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Delphine Weil
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Vincent Di Martino
- Department of Hepatology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Olivier Sutter
- Interventional Radiology Unit, Avicenne Hospital, Paris-Seine-Saint-Denis University Hospitals, Assistance-Publique Hopitaux de Paris, 93000, Bobigny, France
| | - Michel Greget
- Department of Radiology, Strasbourg University Hospital, 67200, Strasbourg, France
| | | | - Mathilde Vionnet
- Department of Radiology, CHU de Poitiers, 86000, Poitiers, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, 49100, Angers, France
| | - Fatima-Zohra Mokrane
- Department of Radiology, University of Toulouse III Paul Sabatier, 31062, Toulouse, France
| | - Julien Ghelfi
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | | | - Christian Sangel
- Department of Radiology, University of Grenoble-Alpes, 38700, Grenoble, France
| | - Agnes Rodes
- Department of Radiology, Hôpital de la Croix Rousse, Centre Hospitalier Universitaire de Lyon, 69004, Lyon, France
| | - Jean Goupil
- Department of Radiology, CHU de Nîmes, 30900, Nîmes, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France; EA 4662 Nanomedicine Lab, Imagery and Therapeutics, University of Franche-Comté, 25030, Besançon, France
| | - Frederic Douane
- Department of Radiology, CHU de Nantes, 44000, Nantes, France
| | - Romaric Loffroy
- Department of Radiology, CHU Dijon-Bourgogne, 21079, Dijon, France
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- Club Francophone pour l'Étude de l'Hypertension Portale (CFEHTP)
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Rozé B, Najioullah F, Fergé JL, Dorléans F, Apetse K, Barnay JL, Daudens-Vaysse E, Brouste Y, Césaire R, Fagour L, Valentino R, Ledrans M, Mehdaoui H, Abel S, Leparc-Goffart I, Signate A, Cabié A, Aïm V, Arrigo A, Cabre P, Chabartier C, Colombani S, Cuziat J, Deligny C, Desbois N, Dessoy AL, Dunoyer G, Duvauferrier R, Duc N, Edimonana M, Garrigou P, Gaucher S, Gourgoudou S, Guitteaud K, Hochedez P, Ivanes G, Jacquens Y, Julié S, Jean-Etienne A, Jeannin S, Julien J, Jérémie P, Lamaignère JL, Laudarin I, Le Gall M, Legris-Allusson V, Mejdoubi M, Michel C, Michel F, Miossec C, Moinet F, Minerva C, Olive C, Olive P, Pailla K, Paysant C, Pierre-François S, Pircher M, Polomat K, Putot A, René-Corail P, Resiere D, Richer C, Risson JR, Rome K, Sabia M, Schloesser M, Simonnet-Vigeral P, Théodose R, Vilain R. Guillain-Barré Syndrome Associated With Zika Virus Infection in Martinique in 2016: A Prospective Study. Clin Infect Dis 2018; 65:1462-1468. [PMID: 29020245 DOI: 10.1093/cid/cix588] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/06/2017] [Indexed: 11/14/2022] Open
Abstract
Background Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016. Methods We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS. Results Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease. Conclusions ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
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Affiliation(s)
- Benoît Rozé
- Infectious and Tropical Diseases Unit, University Hospital of Martinique.,Intensive Care Unit, University Hospital of Martinique
| | - Fatiha Najioullah
- Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France
| | | | - Frédérique Dorléans
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | | | - Elise Daudens-Vaysse
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | - Raymond Césaire
- Laboratory of Virology, University Hospital of Martinique, Université des Antilles EA4537, Fort de France
| | - Laurence Fagour
- Laboratory of Virology, University Hospital of Martinique, Fort de France
| | | | - Martine Ledrans
- French National Public Health Agency, Regional Unit Antilles Guyane, Saint-Maurice
| | | | - Sylvie Abel
- Infectious and Tropical Diseases Unit, University Hospital of Martinique
| | | | | | - André Cabié
- Infectious and Tropical Diseases Unit, University Hospital of Martinique, Université des Antilles, EA4537, INSERM CIC1424, Fort de France, France
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Aubry S, Risson JR, Kastler A, Barbier-Brion B, Siliman G, Runge M, Kastler B. Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skeletal Radiol 2013; 42:1143-50. [PMID: 23708047 DOI: 10.1007/s00256-013-1649-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/03/2013] [Accepted: 05/04/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to assess the elastic and anisotropic properties of normal calcaneal tendon in vivo by transient shear wave elastography (SWE). MATERIALS AND METHODS This study was approved by our institutional ethics committee. Eighty healthy subjects over 18 years of age were prospectively included. Data on the patients' height, weight, sporting activities, and take-off foot were assessed. The thickness, width, and cross-sectional area of the calcaneal tendons were measured. The shear wave propagation velocity (Vmean) was measured by three radiologists on axial and sagittal SWE images at four different degrees of ankle flexion, enabling to calculate elasticity modulus (Emean), and relative anisotropy coefficient (A) values. RESULTS In complete plantar flexion, Vmean was 6.8 ± 1.4 m.s(-1) and 5.1 ± 0.8 m.s(-1), respectively, on the sagittal and axial SWE image, resulting in an elastographic anisotropy A of 0.24 ± 0.16. The best interobserver correlation coefficient of Emean and Vmean was 0.43 and 0.46, respectively, in the sagittal SWE for complete plantar flexion. Vmean and Emean significantly increase when the tendon is stretched by ankle dorsiflexion. The maximal values in sagittal SWE were Vmean = 16.1 ± 0.7 m.s(-1), Emean = 779.5 ± 57.1kPa and A = 0.63 ± 0.07. CONCLUSIONS SWE allows the elastic properties of the calcaneal tendon to be evaluated quantitatively in vivo, but interobserver reproducibility is questionable. It confirms the tendinous elastographic anisotropy and stiffness augmentation of stretched tendon.
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Affiliation(s)
- Sébastien Aubry
- Department of Radiology, University Hospital of Besancon, Boulevard Fleming, 25030, Besançon Cedex, France.
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