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Background: Venous thromboembolism (VTE) and cancer are strongly associated. In France, evidence on patients with pancreatic, upper GI [gastrointestinal], lower GI, lung, or breast cancer-associated VTE and their hospital management is limited. The aims of this study were to provide data on the number of hospitalized VTE events among cancer patients, the patients' characteristics, and their hospital management to estimate the burden of disease and the hospital burden of cancer-related VTE and to provide guidance on research. Methods: This longitudinal, observational, and retrospective study was based on the comprehensive hospital discharge database (PMSI). Adult patients (≥ 18 years old) hospitalized with a cancer of interest in 2016 and hospitalized (within 2 years with VTE (captured a as a principal, related, or significant associated diagnosis) were included in the study. Results: We identified 340,946 cancer patients, of which 7.2% (24,433 patients) were hospitalized with VTE. The proportions of hospitalized VTE were 14.6% (3,237) for patients with pancreatic cancer, 11.2% (8,339) for lung cancer, 9.9% (2,232) for upper GI cancer, 6.7% (7,011) for lower GI cancer, and 3.1% (3,614) for breast cancer. Around two thirds of cancer patients with a hospitalized VTE had active cancer (with metastases and/or receiving chemotherapy during the six months prior to the index date): from 62% of patients with pancreatic cancer to 72% with breast cancer. Around a third of patients were admitted to the hospital through the emergency room, up to 3% of patients stayed in an intensive care unit. The average length of stay ranged from 10 (breast cancer) to 15 days (upper GI cancer). Nine (lower GI cancer) to 18% (pancreatic cancer) of patients died during the VTE hospital stay. Conclusions: The burden of cancer-associated VTE is substantial, both in terms of the number of patients affected and in the hospital use. These findings offer guidance on future research on VTE prophylaxis in a very high-risk population, particularly in patients with active cancer. [ABSTRACT FROM AUTHOR]

Low molecular weight heparins (LMWH) are the standard of care for the treatment of cancer-associated venous thromboembolism (CA-VTE). We performed a systematic review and meta-analysis to compare the effects of direct oral anticoagulants (DOAC) versus LMWH for the treatment of CA-VTE. The primary efficacy and safety outcomes were VTE recurrence and major bleeding (MB). The secondary outcomes were clinically relevant non-MB (CRNMB), all-cause mortality and the net clinical benefit. We searched MEDLINE, EMBASE, CENTRAL and Web of Science (inception-December 2019) and abstracts of relevant conferences (2000–2019) to identify randomized controlled trials comparing DOAC and LMWH for the treatment of CA-VTE. Relative risks (RR) and 95% confidence intervals were estimated (Mantel–Haenszel method, random-effects models). A non-inferiority analysis with a margin of 1.3 for the upper boundary of the RR was conducted for the primary outcomes. From 637 references, we included four publications which encompass three trials (1756 patients). Compared to LMWH, DOAC were associated with a trend for decreased VTE recurrence (RR 0.51; 95%CI 0.25–1.03; p = 0.06; I2 = 51%), whereas MB (RR 1.64; 95%CI 1.00–2.69; p = 0.05; I2 = 0%) and CRNMB (RR 1.83; 95%CI 1.04–3.20; p = 0.03; I2 = 50%) were significantly more frequent with DOAC. Conversely, all-cause mortality (RR 1.06; 95%CI 0.83–1.35; p = 0.64; I2 = 36%) and net clinical benefit (RR 0.74; 95%CI 0.38–1.42; p = 0.36; I2 = 65%) were comparable. DOAC were non-inferior to LMWH in preventing CA-VTE recurrence, but were associated with an increased risk of MB and CRNMB. Further studies are required to confirm these results and inform on the risk/benefit ratio for specific populations. [ABSTRACT FROM AUTHOR]

Bertoletti L, Le Gal G, Aujesky D, Roy P-M, Sanchez O, Verschuren F, Bounameaux H, Perrier A, Righini M. (University of Geneva, Geneva, Switzerland; Université De Saint-Etienne, Jean Monnet, Saint-Etienne; Brest University Hospital, Brest, France; Bern University Hospital, Bern, Switzerland; Angers University Hospital, Angers; Paris Descartes University, Paris, France; Saint-Luc University Hospital, Bruxelles, Belgium; and University of Geneva, Geneva, Switzerland). Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out. J Intern Med 2011; : 433-440. The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients. Retrospective analysis of data obtained during a prospective multicentre management study. Six general and teaching hospitals in Belgium, France and Switzerland. In 1334 patients in whom PE was ruled out, 3-month mortality data were available (hospital readmission status was unknown for three patients) and clinical probability was evaluated with the revised Geneva score (RGS). Three-month mortality and readmission rates. Three-month mortality and readmissions rates were 3% and 19%, respectively and differed significantly depending on the RGS-determined PE probability group ( P < 0.001). When compared with patients presenting with a low probability, the risk of death after 3 months was higher in cases of intermediate or high RGS-based probability {odds ratio: 8.7 [95% confidence interval (CI): 2.7-28.5] and 22.6 (95%CI: 2.1-241.2), respectively}. The readmission risk increased with PE probability group ( P < 0.001). The main causes of death were cancer, respiratory failure and cardiovascular failure. In total, 86% of patients with low RGS-based probability were alive and had not been readmitted to hospital, whereas other patients had a twofold increased risk of death or readmission during the 3-month follow-up. The simplified Geneva score, calculated a posteriori, gave similar results. Initial assessment of clinical probability may help to stratify prognosis of patients in whom PE has been ruled out. Patients with a low probability of PE have a good prognosis. Whether patients with higher probability might benefit from more vigilant care should be evaluated. [ABSTRACT FROM AUTHOR]

Background: Blunt thoracic trauma is a major concern in critically ill patients. Repeated lung diagnostic evaluations are needed in order to follow up the clinical situation and the results of the therapeutic strategies. The aim of this prospective clinical study was to evaluate the possible role of lung ultrasound (LU) compared with bedside radiography (CXR) and computed tomography (CT) used as the gold standard in the evaluation of trauma patients admitted to the intensive care unit with acute respiratory failure. Method: A total of 15 thoracic trauma patients were studied at intensive care unit (ICU) arrival (T1) and 48 h later (T2) with CT, CXR and LU. We evaluated the presence of pleural effusion (PE) and lung contusion (LC). For this purpose the lung parenchyma was divided into 12 regions so that we could compare 180 lung regions at T1 and T2, respectively. Results: Sensitivity of ultrasound was 0.94 for PE and 0.86 for LC while specificity 0.99 and 0.97, respectively. The likelihood ratio was 94 (ρ+) and 0.06 (ρ−) for PE and 28.6 (ρ+) and 0.14 (ρ−) for LC. Conclusions: Ultrasound provides a reliable noninvasive, bedside method for the assessment of chest trauma patients with acute respiratory failure in the ICU. [ABSTRACT FROM AUTHOR]

We present our initial clinical experience with a recently introduced 64-detector computed tomography (64-MDCT) scanner that makes use of a periodic motion of the focal spot in the longitudinal direction (z-flying focal spot), which enables it to reach a final spatial resolution of 0.4×0.4×0.4 mm3 and a temporal resolution of 83 ms. A total of 114 patients (108 men, six women; age range 36–77 years, mean 63.1 years) underwent retrospective electrocardiogram (ECG)-gated examination of the coronary arteries using a 64-MDCT scanner (Somatom Sensation 64, Siemens Medical Solutions, Germany). Acquisition parameters were the following: collimation 64×0.6 mm, 800 quality reference milliampere second (mAs), 120 kVp, 0.33-s gantry rotation time and pitch 0.2. Images were acquired in all cases after i.v. administration of 80 ml of contrast agent (Iomeron 400 mgI/dl, Bracco, Italy) + 30 ml of saline at 4 /s and delay time determined using a bolus triggering technique. Oral betablockers were administered to patients with heart rate (HR) >75 bpm. To reduce radiation exposure, an automatic exposure control system was applied in all cases to adapt tube current to patient size and anatomic shape (CARE Dose 4D, Siemens Medical Solutions, Germany). The optimal temporal window for raw data reconstruction was chosen from an initial preview of images reconstructed with different phase settings (range 0%–95% RR interval with 5% gap) at a selected anatomical level in the mid part of the right coronary artery. CT dose index volume and effective dose were quantified in all patients using dedicated software. Mean HR recorded during image acquisition was 65.6±19.2 bmp (range: 44–96 bmp), and beta-blockers were administered to 16/114 patients (14.0%). Technical adequacy was achieved in all patients but two (2/114; 1.7%). In patients with HR <60 bmp, the best reconstruction intervals were identified in the end-systolic (30%–35% of the RR interval) and end-diastolic (60%–65% of the RR interval) phases; with faster HR (>80 bmp), high image quality was observed in end-systole (30%–35% of the RR interval). Mean CT dose index (CTDI) volume was 36.53±8.30 mGy per patient. In comparison with a conventional examination with fixed mAs, the use of the CARE Dose 4D system provided a 33.3% CTDI volume reduction ( p<0.001). Mean effective dose was 9.5±3.4 millisievert (mSv) per patient (range 7.1–17.7). The 64-MDCT scanner diagnostic performance for coronary CT angiography is further improved with better spatial and temporal resolution and faster scan times; besides, initial clinical results are promising. The use of dose-reducing acquisition techniques is mandatory to limit radiation exposure to the patient. [ABSTRACT FROM AUTHOR]

The aid of this study was to evaluate lung volume reduction with multidetector-row computed tomography (MDCT) in patients with emphysema who have undergone endobronchial valve placement. Nine patients with emphysema were studied by low-dose chest MDCT (64-slice Somatom Sensation Cardiac, Siemens) with a collimation of 64x0.6 mm and a slice thickness of 1 mm. After treatment, MDCT scans were repeated at 7 and 30 days. A single observer calculated the volume of the treated lobe and of both lungs on a dedicated console. Volume calculations were then compared with the results of lung function tests. Four patients in whom MDCT showed severe emphysema of the right upper lobe (RUL) were selected for endobronchial valve insertion. Volume assessment at 30 days showed a 29% reduction in RUL volume in patient A, a 15% reduction in patient B, a <1% reduction in patient C and a 30% reduction in patient D. Correlation with lung function tests confirmed a major reduction of forced expiratory volume in 1 s (FEV1) and vital capacity (VC) and improved walking test results after 7 and 30 days. In patients undergoing endobronchial valve placement, MDCT with dedicated software allows for a better evaluation of volume reduction of a single lobe and of the whole lung. [ABSTRACT FROM AUTHOR]

The purpose of this study was to establish the diagnostic value of multidetector–row computed tomography (MDCT) angiography compared with digital subtraction angiography (DSA) for detection and quantification of both main and accessory renal artery stenosis in patients with secondary hypertension. Fifty consecutive patients scheduled for DSA were considered candidates for MDCT angiography. In all patients, MDCT angiography of the abdominal aorta was performed before DSA. For the purpose of interpretation, the arteries were separately interpreted either with DSA or MDCT angiography in order to provide qualitative and quantitative information. For qualitative evaluation, one experienced reader graded the opacification of renal arteries as excellent, good or poor; for quantitative evaluation, MDCT and DSA were independently evaluated for the number of renal arteries and the presence, location and degree of stenosis in random order by three readers. On the basis of consensus readings, calculations of sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) for detection of degree of stenosis were made by using DSA findings as the standard of reference. Interobserver variability was also assessed. With regard to qualitative analysis, arterial enhancement was considered excellent in 39 patients and good in 11. For quantitative analysis, 73 arteries were classified as normal with DSA. Although 72 of these were also classified as normal with CT angiography, one was overestimated by one grade; at DSA, 16 arteries were classified as moderately stenotic; in two arteries, there was an overestimation of one grade. Perfect correlation was achieved for the diagnosis of occlusion. In two patients, all three readers detected multiple severe stenoses on both modalities, with a “string–of–beads” appearance typical of fibromuscular dysplasia. Accessory arteries were correctly identified as such by all three readers on either DSA or MDCT. Levels of sensitivity, specificity and accuracy regarding degree of stenosis were 100%, 98.6% and 96.9%, respectively, with PPV and NPV of 97.6% and 100%, respectively. When we considered significant arterial stenosis (50%–100% luminal narrowing), sensitivity, specificity and accuracy were 100%, 97.3% and 97.8%, respectively, with a PPV and NPV of 98.2% and 97.8%, respectively. For all observers, interobserver agreement was almost perfect (k=0.81–1) for both MDCT and DSA, with a k value between 0.82 and 0.95. MDCT angiography is very accurate and robust, even for the assessment of renal artery stenosis, and has the potential to become a viable substitute, in most cases, for diagnostic catheter–based DSA. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the efficacy of a Computer–Aided Detection (CAD) system in the identification of lung metastases and to compare the volumetric CAD measurements with unidimensional observer measurements in the evaluation of treatment response in oncology patients. Two observers (A and B) evaluated nine patients undergoing lung computed tomography (CT) just before and immediately after treatment with chemotherapy. Multislice CT scans were performed before and after the injection of contrast material with a high–resolution protocol (collimation 4x1 mm, 100 mAs, 120 kV). Response Evaluation Criteria in Solid Tumours (RECIST) criteria were used to consider the disease as stable, increased or decreased. Subsequently, target lesions (most significant lesions identified before and after chemotherapy) were evaluated with a computerised system (CAD) to establish volumetric measurements. Observers’ unidimensional measurements and CAD volumetric measurements were analysed for comparison. Twenty–four nodules (diameter: 5–18 mm in the first study and 4–20 mm in the follow–up study) were included. Observers agreed in the assessment of therapy response in 21 nodules: eight were considered to have increased in size, and 13 were judged stable. Observer and CAD measurements disagreed in three nodules: two were considered stable by radiologists and increased by CAD; one was considered increased by radiologists and stable by CAD. As regards patient response, radiologists disagreed in two cases. CAD and observers did not agree in one case. Our preliminary data suggest that volumetric measurements can modify the diagnostic and therapeutic evaluation of oncology patients under chemotherapy. CAD volumetric measurements allow an easy and objective evaluation, reducing interobserver variability in the evaluation of chemotherapy response. [ABSTRACT FROM AUTHOR]

The article presents information about the advantages and clinical applications of the imaging technology multidetector-row helical CT (MDCT) in the evaluation of the abdominal aorta. This technology enables to acquire multiple simultaneous slices using a high rotation gantry speed. MDCT also enables true isotropic spatial resolution. Moreover, with the help of this technology, demonstration of the juxtarenal or suprarenal extension of the aneurysm is possible.