Lindenhofspital

A pelvic arteriovenous malformation (AVM) is a rare congenital vascular anomaly that may cause relevant clinical symptoms. This systematic review synthesizes current evidence on diagnostic approaches, embolization techniques, and clinical outcomes for pelvic AVMs. A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-compliant literature search identified 19 studies comprising 49 patients treated with embolization therapy. Venous approaches, including direct puncture of a dominant outflow vein (DOV), were most commonly performed. Coils were the primary embolic agent, frequently combined with adjunctive materials, reflecting substantial technical heterogeneity. Despite this variability, embolization achieved consistently high technical and clinical success rates with low complication rates over a mean follow-up of 21.1months. Embolization therapy of DOV may be considered as first-line therapy for symptomatic pelvic AVMs, although future comparative studies are needed to guide standardized treatment strategies.

The present study aimed to evaluate the midterm efficacy and safety of venous leak embolization in patients with erectile dysfunction (ED) who did not respond to phosphodiesterase-5 inhibitors. From October 2019 to June 2024, ED patients with venous leakage were included from a prospective, multicenter, all-comers, investigator-initiated registry. A mixture of ethiodized oil and modified cyanoacrylate-based glue n-butyl 2 cyanoacrylate monomer (NBCA) was used as liquid embolic agent. Before embolization, venous leak was classified on computed tomography cavernosography. The primary safety outcome measure was any major adverse event up to 12weeks after the procedure. The primary feasibility outcome measure was IIEF-15 (International Index of Erectile Function-15) score improvement ≥ 4 points in ≥ 50% of the subjects at up to 3months, 1year, and annually thereafter. One hundred seventy-five consecutive patients with venous leak were included. Successful venous leak embolization was achieved in 193/194 (99.5%) of cases. Nontarget embolization (pulmonary embolisms) occurred in 3/175 (1.7%) patients. The primary feasibility outcome measure at 9.2 ± 11.3months was achieved by 82/138 (59.4%) patients. IIEF-15 scores were 31 ± 22 at baseline, 45 ± 35 up to 3months, and 43 ± 24 at one year. Eighteen of the 175 patients (10.2%) experienced venous leak recurrence (n = 16) or persistence (n = 2) after embolization at 16.1 ± 14.3months. Venous leak embolization was effective at midterm follow-up in the majority of patients. Venous leak recurrence is rare due to venous leak recanalization or new collateral vein formation.

[This corrects the article DOI: 10.3389/frai.2024.1431156.].

PurposeThis retrospective cohort study investigated whether back protectors reduce the incidence and severity of spinal injuries in alpine winter sports, hypothesizing they may affect the type, location, and severity rather than fully prevent them.MethodsWe retrospectively identified patients with alpine winter sports-related injuries admitted to our Level-1 trauma center (2017–2023). Patient and accident data were gathered via phone survey and chart review. Injuries were classified using the AO Spine system, and the impact of back protectors was analyzed using univariate and multivariate analysis in R.ResultsOut of 1160 identified patients, 232 (81 spinal injuries, 151 non-spinal injuries) completed telephone follow-up (mean 52 months post-injury, SD 19.8). The presence of a spinal injury was not significantly associated with back protector use, but spinal injuries in protector users were more frequently treated conservatively, while non-users required operative treatment slightly more frequently (p = 0.13) and presented with neurological deficits (p = 0.008). After adjusting for confounders, there was no significant reduction in ISS scores. Moreover, wearing a back protector did not significantly impact the overall occurrence of polytrauma.ConclusionBack protectors neither prevented spinal injuries nor provided beneficial protection in polytrauma cases among patients presenting to our level I trauma center.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00068-025-02983-8.

MRI is well established for diagnosing GCA. Its role in monitoring disease activity has yet to be determined. We investigated vascular and musculoskeletal inflammation using MRI in the patients of the GUSTO trial to assess the utility of MRI in monitoring disease activity. Eighteen patients with newly diagnosed GCA received 500 mg methylprednisolone intravenously for three consecutive days followed by tocilizumab monotherapy from day 3 until week 52. Cranial, thoracic and abdominal MRI exams were performed at baseline (active, new-onset disease), and at weeks 24, 52 (remission on-treatment) and 104 (remission off-treatment). MRI findings typical for PMR as well as extent and severity of vasculitic disease were rated. In total, 673 vascular segments and 943 musculoskeletal regions in 55 thoracic/abdominal MRI and 490 vascular segments in 49 cranial MRI scans of 18 patients were analysed. Vasculitic vessels were still detectable in one in four cranial segments at week 24. At weeks 52 and 104, no cranial vascular segment showed a vasculitic manifestation. Large vessels, except for the ascending aorta, and PMR displayed little or no decrease in inflammatory findings over time. Vasculitic manifestations in the cranial vessels normalized after 52 weeks of treatment, whereas large vessel and PMR findings persisted despite lasting full remission. The dynamics of cranial vessel signals suggest that MRI of these arteries might qualify as a potential diagnostic tool for monitoring disease activity and for detecting relapse after 52 weeks of treatment.

This study investigated whether parathyroid hormone (PTH) lowering with etelcalcetide, and the consequent effects on mineral and bone metabolism, could improve serum calcification propensity (T50 time) and decrease calciprotein particle (CPP) load in hemodialysis patients with secondary hyperparathyroidism. In this single-arm, prospective, dose-escalation proof-of-principle study, hemodialysis patients received etelcalcetide at 2.5mg/dialysis session with increments of 2.5mg every 4 weeks to a maximum dose of 15mg three times a week or until a pre-specified safety endpoint was reached, followed by an 8-week wash-out phase. Out of 36 patients recruited (81% male, 62±13 years), 16 patients completed the study per protocol with a mean maximum tolerated dose of etelcalcetide of 9.5±2.9mg/dialysis session. With escalating doses of etelcalcetide, PTH and serum calcium levels significantly decreased (P<0.0001). While there was no significant change in T50 times or serum phosphate levels, etelcalcetide did yield significant and consistent reductions in serum levels of endogenous calciprotein monomers [-35.4 (-44.4 to -26.5)%, P<0.0001], primary [-22.4 (-34.5 to -10.3)%, P<0.01] and secondary CPP [-29.1 (-45.7 to -12.4)%, P<0.01], an effect that was reversed after therapy withdrawal. Serum levels of osteoclastic markers significantly decreased with escalating doses of etelcalcetide, while levels of the osteoblastic marker remained stable. Lowering of PTH with etelcalcetide did not result in statistically significant changes in T50. By contrast, homogenous reductions in serum levels of calciprotein monomers, primary and secondary CPP were observed.

To report on the surgical safety and quality of pelvic lymph node dissection (PLND) in patients treated with radical cystectomy (RC) and PLND for muscle-invasive bladder cancer (MIBC) after neoadjuvant chemo-immunotherapy. The Swiss Group for Clinical Cancer Research (SAKK) 06/17 was an open-label single-arm phase II trial including 61 cisplatin-fit patients with clinical stage (c)T2-T4a cN0-1 operable urothelial MIBC or upper urinary tract cancer. Patients received neoadjuvant cisplatin/gemcitabine and durvalumab followed by surgery. Prospective quality assessment of surgeries was performed via central review of intraoperative photographs. Postoperative complications were assessed using the Clavien-Dindo Classification. Data were analysed descriptively. A total of 50 patients received RC and PLND. All patients received neoadjuvant chemo-immunotherapy. The median (interquartile range) number of lymph nodes removed was 29 (23-38). No intraoperative complications were registered. Grade ≥III postoperative complications were reported in 12 patients (24%). Complete nodal dissection (100%) was performed at the level of the obturator fossa (bilaterally) and of the left external iliac region; in 49 patients (98%) at the internal iliac region and at the right external iliac region; in 39 (78%) and 38 (76%) patients at the right and left presacral level, respectively. This study supports the surgical safety of RC and PLND following neoadjuvant chemo-immunotherapy in patients with MIBC. The extent and completeness of protocol-defined PLND varies between patients, highlighting the need to communicate and monitor the surgical template.