Hôpital Privé Jacques Cartier

Outcomes after intervention for chronic venous insufficiency (CVI) is difficult to predict. This study aimed to develop machine learning (ML) models to predict 90-day clinical improvement after varicose vein surgery and identify key factors. This retrospective multicenter study included patients with CVI undergoing first-time varicose vein surgery between 2014 and 2024. CVI was classified according to the Clinical-Etiologic-Anatomic-Pathophysiologic (CEAP) classification and Venous Clinical Severity Score (VCSS). Clinical improvement at 90 days was defined as any decrease in CEAP stage. Three ML classifiers (Logistic Regression, Random Forest, and XGBoost) were trained to predict improvement, with nested stratified cross-validation and undersampling to address class imbalance. In total, 4015 patients were included and 87.6% showed clinical improvement at 90 days. Non-improved patients were older, had higher body mass index (BMI), and higher baseline VCSS and CEAP scores. Random Forest achieved the best overall performance, with an accuracy of 80%, recall of 75%, and F1-score of 0.49 to predict the lack of improvement, indicating effective identification of at-risk individuals. Key predictors included baseline CEAP and VCSS scores, BMI, age, and surgical variables. The overall predictive performance of ML was modest, but the models highlighted patients at risk of poor outcomes.

The aim of this study is to evaluate the second medical opinions (SMOs) clinical value for endometriosis diagnostic strategy and patient profiles, using nationwide data from a specialized French physician network dedicated to SMOs and endometriosis management. We conducted an observational cohort study including patients from France who submitted a request for an SMO through a dedicated platform ( https://www.deuxiemeavis.fr/ ) between January 1st, 2020, and March 31st, 2024. Patients completed predefined questionnaires and subsequently received a written report following the expert SMO. A total of 3,061 patients requested a SMO for endometriosis. Most patients (61.1%) declared experiencing chronic painful symptoms a negative impact on daily life, corresponding to an Eastern Cooperative Oncology Group (ECOG) score ≥ 1. Dysmenorrhea was reported by 50.7% of patients, and 69.4% reported interruption of intercourse due to pain. Among the 2,987 patients with a complete medical record, the SMO modified the diagnosis in 51.1% of cases. After SMO, experts were unable to establish a conclusion in only 5.0% of cases, compared to 24.7% after the first medical opinion. For patients finally diagnosed with endometriosis, the SMO provided a diagnosis at a mean of 3.8 ± 1.5 years after symptom onset. Seeking a SMO with access to medical experts can be essential for patients dealing with painful symptoms unsuccessfully treated, or other problems such as endometriosis diagnosis.

BackgroundLeft ventricular (LV) pseudoaneurysm is a rare but potentially fatal complication, typically resulting from a contained rupture of the LV free wall after myocardial infarction or cardiac surgery.Case SummaryWe report the case of a 65-year-old woman in whom a giant LV pseudoaneurysm was incidentally identified, likely as a late consequence of pericardiocentesis. Multimodality imaging, including cardiac computed tomography and transesophageal echocardiography, was essential for diagnosis and procedural planning. Given the patient's comorbidities and anatomic suitability, the heart team opted for percutaneous closure. A transseptal approach was used, with real-time computed tomography fluoroscopy fusion imaging to guide deployment of an Amplatzer muscular ventricular septal defect occluder. The intervention was successful, achieving complete exclusion of the pseudoaneurysm.DiscussionThis case illustrates the feasibility and safety of transcatheter closure in high-risk patients.Take-Home MessagePercutaneous closure guided by fusion imaging is a viable alternative for managing LV pseudoaneurysms in high-risk surgical candidates.