The effect of transradial coronary catheterization on upper limb function

OBJECTIVES

The aim of this study was to analyze the change of upper limb function when percutaneous coronary procedures were performed through the radial artery.

BACKGROUND

It is currently unknown if upper limb function is affected by transradial (TR) catheterization.

METHODS

Between January 2013 and February 2014, upper limb function was assessed in a total of 338 patients undergoing coronary catheterization in an ambulatory setting (85% radial approach, 15% femoral approach). Upper limb function was assessed with the self-reported shortened version of the Disabilities of Arm, Shoulder, and Hand questionnaire. The presence and severity of upper extremity cold intolerance was assessed with the self-reported Cold Intolerance Symptom Severity questionnaire. Both questionnaires were completed before the catheterization and at 30-day follow-up. Higher scores represent worse upper limb functionality or symptoms. The nonparametric Wilcoxon signed-rank test was used to assess the change of upper limb function and symptoms over time.

RESULTS

Upper limb function did not change significantly over time when catheterization was performed through the radial artery (p=0.06). The number of procedure-related extremity complaints that persisted during 30-day follow-up were not different between both access groups (TR access 10.5%, transfemoral access 11.5%; p=0.82). The upper extremity was not affected by cold intolerance after TR access at 30-day follow-up (p=0.91).

CONCLUSIONS

Upper limb function was not affected when coronary catheterizations and interventions were performed through the radial artery.

[A giant pseudocyst following repair of an incisional hernia by a propylene mesh]

A 79-year-old woman presented with a huge, asymptomatic, balloon-like abdomen, which gradually developed after polypropylene mesh repair of an incisional hernia following a median laparotomy. Additional CT showed a huge cyst measuring 20 x 24 cm which seemed to originate from the anterior abdominal wall and lacked communication with the inner abdominal space. Subsequently an explorative laparotomy was performed. The content of the cyst consisted of dark brown serosanguineous material. The inferior portion was firmly affixed to the mesh. The entire cyst, except for the part fixed to the mesh, was excised followed by an abdominoplasty. Histological examination showed aspecific signs of inflammation due to a foreign body, and haemorrhagic material without epithelial lining. The diagnosis 'giant pseudocyst' was established. Etiologically, this condition is probably related to postoperative formation of a seroma, which is a well-known complication after mesh repair, especially when a polypropylene mesh is used. Postoperative formation of a haematoma might be a causative factor as well. Former literature reports 11 cases of such giant cyst formation after mesh repair ofhernias. In one study a prevalence of 0.45% is mentioned. This complication may be an underreported phenomenon.

Crouzon Syndrome: Phenotypic Signs and Symptoms of the Postnatally Expressed Subtype

In a retrospective study, the characteristics of a group of patients (n = 9) with a postnatally expressed Crouzon syndrome were described. Although they do not always display the physical signs of craniosynostosis, such patients are highly at risk of developing symptoms secondary to multiple suture synostosis. By reviewing the hospital files, radiographs, and three-dimensional computed tomography scans of these patients, it was possible to describe the pattern of suture obliteration chronologically. Furthermore, certain phenotypic signs and symptoms such as skull shape and development of digital impressions, a bulge at the bregma, and intracranial hypertension were inventoried as well as patients' genotypes. Interestingly, ossification started at the lambdoid sutures in at least four patients and most likely in three additional ones. The coronal sutures were the last to ossify in at least three of the patients. Various skull shapes were encountered. Furthermore, all nine patients developed digital impressions, starting occipitally in eight of them. Seven patients developed a bulge at the bregma, and four of them exhibited intracranial hypertension. The genotype varied in our patients. To recognize patients with postnatal Crouzon syndrome as soon as possible, special attention must be paid to 1) occipital development of digital impressions and/or ossification of sutures, 2) development of a prominent bregma, 3) development of intracranial hypertension, and/or 4) progressive characteristic "crouzonoid" features. Such patients can be considered as representing a subtype of Crouzon syndrome. To prevent or treat intracranial hypertension and/or loss of vision, surgical intervention should be performed at the onset of progressive craniosynostosis between 1 and 2 years of age.