BackgroundPatients with pituitary stalk interruption syndrome (PSIS) are initially referred for hypoglycemia during the neonatal period or growth retardation during childhood. PSIS is either isolated (nonsyndromic) or associated with extra-pituitary malformations (syndromic).ObjectiveTo compare baseline characteristics and long-term evolution in patients with PSIS according to the initial presentation.Study DesignSixty-seven patients with PSIS were included. Data from subgroups were compared: neonates (n = 10) versus growth retardation patients (n = 47), and syndromic (n = 32) versus nonsyndromic patients (n = 35).ResultsNeonates displayed a more severe hormonal and radiological phenotype than children referred for growth retardation, with a higher incidence of multiple hormonal deficiencies (100% versus 34%; P = 0.0005) and a nonvisible anterior pituitary lobe (33% versus 2%; P = 0.0017). Regular follow-up of growth might have allowed earlier diagnosis in the children with growth retardation, as decreased growth velocity and growth retardation were present respectively 3 and 2 years before referral. We documented a progressive worsening of endocrine impairment throughout childhood in these patients. Presence of extra-pituitary malformations (found in 48%) was not associated with more severe hormonal and radiological characteristics. Growth under GH treatment was similar in the patient groups and did not vary according to the pituitary MRI findings.ConclusionsPSIS diagnosed in the neonatal period has a particularly severe hormonal and radiological phenotype. The progressive worsening of endocrine impairment throughout childhood justifies periodic follow-up to check for additional hormonal deficiencies.

A bdominal aortic aneurysm (AAA) is a serious and common pathologic abnormality that accompanies aging. Among men older than 65 years, the prevalence of AAA reaches 7.7%, increasing from 5.7% in ages 64-69 years to 8.9% in individuals older than 74 years (1). The high overall mortality from ruptured AAAs makes growth and subsequent rupture risk assessment crucial for AAA management.Since the 1970s, many studies (2) have demonstrated that AAA diameter correlates with rupture rate. Accordingly, AAA maximum diameter, effectively measured by using diagnostic US, has been the primary prognostic variable used to determine patient care (3,4). Current guidelines dictate elective repair to be appropriate at a diameter threshold of 50-55 mm or for AAA exhibiting growth greater than 1 cm per year (5,6).However, whereas some AAAs smaller than 55 mm do not grow more than 1 cm per year (7), other AAAs that are too small to trigger intervention grow rapidly. The sole use of maximal diameter measurement may be insufficient to

Extracardiac findings by CT during MPI are frequent. Patients with major extracardiac findings have a poor mid-term outcome, whatever the results of the myocardial perfusion imaging. Extracardiac findings should be systematically checked when attenuation correction CT is performed.

Purpose The aim of this article is to define the place of new endovascular methods for the management of pulmonary embolisms (PE), on the basis of a multidisciplinary consensus. Method and results Briefly, from the recent literature, for high-risk PE presenting with shock or cardiac arrest, systemic thrombolysis or embolectomy is recommended, while for lowrisk PE, anticoagulation alone is proposed. Normo-tense patients with PE but with biological or imaging signs of right heart dysfunction constitute a group known as “at intermediate risk” for which the therapeutic strategy remains controversial. In fact, some patients may require more aggressive treatment in addition to the anticoagulant treatment, because approximately 10% will decompensate hemodynamically with a high risk of mortality. Systemic thrombolysis may be an option, but with hemorrhagic risks, particularly intra cranial. Various hybrid pharmacomechanical approaches are proposed to maintain the benefits of thrombolysis while reducing its risks, but the overall clinical experience of these different techniques remains limited. Patients with high intermediate and high risk pulmonary embolism should be managed by a multidisciplinary team combining the skills of cardiologists, resuscitators, pneumologists, interventional radiologists and cardiac surgeons. Such a team can determine which intervention – thrombolysis alone or assisted, percutaneous mechanical fragmentation of the thrombus or surgical embolectomy – is best suited to a particular patient. Conclusions This consensus document define the place of endovascular thrombectomy based on an appropriate risk stratification of PE.

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