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British Journal of Hospital Medicine... Jun 2024Although electromyography has been extensively used in the diagnosis of neurological diseases, there is no comprehensive understanding of the electromyography...
Specific electromyography characteristics can distinguish longitudinally extensive transverse myelitis from congestive myelopathy due to spinal dural arteriovenous fistula: a retrospective study.
Although electromyography has been extensively used in the diagnosis of neurological diseases, there is no comprehensive understanding of the electromyography manifestations of spinal dural arteriovenous fistula. Given the widespread use of electromyography in the diagnosis of neurological conditions, it is worthwhile to holistically analyse the electromyography findings of spinal dural arteriovenous fistula to differentiate it from neurological diseases that share similar clinical manifestations. The aim of this study is to evaluate whether electromyography can distinguish spinal dural arteriovenous fistula from longitudinally extensive transverse myelitis. We holistically reviewed files of all patients who were diagnosed with spinal dural arteriovenous fistula or longitudinally extensive transverse myelitis at The First Medical Centre of PLA General Hospital from 1 January 2010 to 31 December 2020. We compared the symptomology, epidemiology, and imaging results of patients with spinal dural arteriovenous fistula and longitudinally extensive transverse myelitis, placing emphasis on their electromyography manifestations. Student's t test was used to analyse normally distributed data, while Chi-square test was used to compare classification statistics. Lesions of spinal dural arteriovenous fistula shown on images tend to appear at lower lumbar and sacral segments, whereas lesions of the cervical and upper thoracic segments are more characteristic of longitudinally extensive transverse myelitis. Spinal dural arteriovenous fistula patients and longitudinally extensive transverse myelitis patients overlap in terms of clinical manifestations. After comparison, the two groups of patients had different demographics (age, sex), onset mode, predisposing factors before onset, and electromyographic features. The electromyographic features of patients with spinal dural arteriovenous fistula were associated with neurogenic damage ( < 0.001). In patients with spinal dural arteriovenous fistula, electromyography can help clinicians to identify early disease, avoid patient treatment delay, and eliminate unnecessary treatment.
Topics: Humans; Electromyography; Male; Female; Myelitis, Transverse; Central Nervous System Vascular Malformations; Retrospective Studies; Middle Aged; Adult; Aged; Diagnosis, Differential; Spinal Cord Diseases; Magnetic Resonance Imaging
PubMed: 38941974
DOI: 10.12968/hmed.2024.0111 -
Pulmonary Circulation Apr 2024
PubMed: 38939305
DOI: 10.1002/pul2.12408 -
Journal of Cardiothoracic Surgery Jun 2024Pulmonary arteriovenous fistula (PAVF) is a rare disease, and its symptoms lack specificity. For patients with coronary heart disease(CHD), hypertension and other common...
BACKGROUND
Pulmonary arteriovenous fistula (PAVF) is a rare disease, and its symptoms lack specificity. For patients with coronary heart disease(CHD), hypertension and other common cardiovascular diseases, PAVF is easy to be ignored. We presented a case of massive PAVF complicated with coronary atherosclerotic heart disease by interventional treatment to improve the understanding of this complex disease.
CASE PRESENTATION
A 77-year-old female patient was admitted to the hospital due to chest tightness and shortness of breath following activities, which was diagnosed with CHD and hypoxemia in other hospitals. Coronary angiography showed that the patient had severe stenosis of coronary artery while pulmonary vascular DSA showing the patient had PAVF. After interventional therapy of both coronary artery and PAVF, the patient's symptoms were significantly improved.
CONCLUSION
We presented a case of massive PAVF complicated with CHD by interventional treatment. For patients with unexplained hypoxemia and symptoms similar with CHD, the possibility of PAVF often leads to oversight, and various auxiliary examinations should be improved to avoid missed diagnosis. And intervention treatment should be carried out to improve the prognosis of patients as much as possible.
Topics: Humans; Female; Aged; Arteriovenous Fistula; Pulmonary Artery; Coronary Artery Disease; Pulmonary Veins; Coronary Angiography
PubMed: 38937815
DOI: 10.1186/s13019-024-02866-w -
Journal of Neurointerventional Surgery Jun 2024Liquid embolization in neuroendovascular procedures carries the risk of embolizing an inappropriate vessel. Operators must pay close attention to multiple vessels during...
BACKGROUND
Liquid embolization in neuroendovascular procedures carries the risk of embolizing an inappropriate vessel. Operators must pay close attention to multiple vessels during the procedure to avoid ischemic complications. We report our experience with real time artificial intelligence (AI) assisted liquid embolization and evaluate its performance.
METHODS
An AI-based system (Neuro-Vascular Assist, iMed technologies, Tokyo, Japan) was used in eight endovascular liquid embolization procedures in two institutions. The software automatically detects liquid embolic agent on biplane fluoroscopy images in real time and notifies operators when the agent reaches a predefined area. Safety, efficacy, and accuracy of the notifications were evaluated using recorded videos.
RESULTS
Onyx or n-butyl-2-cyanoacrylate (NBCA) was used in the treatment of arteriovenous malformation, dural arteriovenous fistula, meningioma, and chronic subdural hematoma. The mean number of true positive and false negative notifications per case was 31.8 and 2.8, respectively. No false positive notifications occurred. The precision and recall of the notifications were 100% and 92.0%, respectively. In 28.3% of the true positive notifications, the operator immediately paused agent injection after receiving the notification, which demonstrates the potential effectiveness of the AI-based system. No adverse events were associated with the notifications.
CONCLUSIONS
To the best of our knowledge, this is the first report of real time AI assistance with liquid embolization procedures in humans. The system demonstrated high notification accuracy, safety, and potential clinical usefulness in liquid embolization procedures. Further research is warranted to validate its impact on clinical outcomes. AI-based real time surgical support has the potential to advance neuroendovascular treatment.
PubMed: 38937087
DOI: 10.1136/jnis-2024-022001 -
The American Journal of Case Reports Jun 2024BACKGROUND Spinal cord arteriovenous fistula that only manifests as lower back pain is easily misdiagnosed as myofasciitis, lumbar spondylosis, and other diseases, and...
BACKGROUND Spinal cord arteriovenous fistula that only manifests as lower back pain is easily misdiagnosed as myofasciitis, lumbar spondylosis, and other diseases, and incorrect treatment such as glucocorticoid blockade might be given, leading to worsening of the condition. CASE REPORT We analyze the clinical characteristics of a patient with spinal dural arteriovenous fistula who presented with chronic-onset low back pain. A patient with spinal dural arteriovenous fistula presented with chronic-onset low back pain as the only symptom, and was misdiagnosed as having myofasciitis. We assessed the paraclinical data, clinical reasoning, and course of treatment. The patient was an elderly man with low back pain for 1 year. He was diagnosed with myofasciitis in a local hospital and received local blocking treatment using glucocorticoid, and left lower-limb weakness appeared after that. After he was admitted to our hospital, enhanced thoracic and lumbar magnetic resonance imaging and selective spinal angiography were performed, and the results indicated the diagnosis of spinal dural arteriovenous fistula. After surgical treatment, the low back pain and lower-limb weakness were alleviated, and the patient is still under follow-up. CONCLUSIONS The possibility of spinal dural arteriovenous fistula should not be overlooked among patients with chronic low back pain, and caution should be taken when using glucocorticoids for treatment of chronic low back pain.
Topics: Humans; Male; Low Back Pain; Central Nervous System Vascular Malformations; Aged; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 38935578
DOI: 10.12659/AJCR.943947 -
Kidney & Blood Pressure Research Jun 2024The aim of the presented prospective observational study was to evaluate the effect of fistula flow on peripheral wave morphology and pulse wave velocity by means of the...
UNLABELLED
The aim of the presented prospective observational study was to evaluate the effect of fistula flow on peripheral wave morphology and pulse wave velocity by means of the oscillometric Vicorder®-device with the purpose of fistula surveillance.
METHODS
Digitized and normalized curves of 53 haemodialysis patients at the fistula and non-fistula arm were analyzed. Slope parameters and the areas under the curve of characteristic sections of pulse waves as well as the power spectrum of the pulse waves and their first and second derivatives were computed. Furthermore, the amplitude of volumetric change (AMP) was assessed. Duplex-sonography served as a reference method.
RESULTS
In the comprehensive set of novel pulse wave parameters significant inter-arm differences were demonstrated and a significant delay of the systolic maximum at the fistula arm in comparison to the non-fistula arm (204 ± 3.4 versus 162 ± 5.3 ms, p<0.001) was proven. Unexpectedly, pulse wave velocity apparently did not differ between both arms (7.85 versus 8.05 m/sec at the fistula/non-fistula side, p=0.942). The inter-arm differences of the slope parameters were more pronounced in forearm than in upper arm fistulas. Finally, we showed that the inter-arm difference of AMP correlated with volume-flow (r= 0.326 with p=0.017).
CONCLUSION
Pulse waves as assessed by oscillometric pulse wave analysis have distinct features at fistula and non-fistula arms. This is due to enhanced arteriovenous flow, i.e. in both the brachial artery and the fistula vein. The analysis of those alterations has the potential to assess fistula function.
PubMed: 38934146
DOI: 10.1159/000539885 -
Annals of Pediatric Cardiology 2024Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review...
BACKGROUND
Aortico right atrial tunnel (ARAT) is a rare extracardiac communication between the aorta and the right atrium with two anatomical types. A recent global review identified 59 patients.
METHODS
Patients with ARAT from two centers were analyzed for their demographics, symptoms, morphology, management, and follow-up thromboprophylaxis.
RESULTS
Among 21 patients including 8 males with a median age of 3 years (18 days-72 years) diagnosed as ARAT, 12 (57%) had posterior tunnels and 9 had anterior tunnels. Four patients had multiple exits. Eighteen tunnels were closed after arteriovenous circuit formation. Six patients (29%) weighing <10 kg presented early with heart failure. Transcatheter closure normalized the hemodynamics including in one infant after failed surgery. Two elderly patients (10%) above 60 years presented with angina and atrial fibrillation. The rest were asymptomatic. Occluders were positioned in the narrow proximal aortic end of the tunnel in all except two patients, where the distal atrial end was closed. All procedures were successful without complications. There was one late death after 1 year from subarachnoid hemorrhage. At a median follow-up of 96 months, all survivors were asymptomatic. Thromboprophylaxis with dual antiplatelets for 1-2 years followed earlier was recently changed to aspirin with Coumadin. Complete remodeling occurred when the proximal aortic end was closed, but partial persistence of the track was noted after distal closure.
CONCLUSIONS
This largest cohort of ARAT showed the safety and efficacy of transcatheter closure even in neonates. The narrow proximal aortic end should be the target for closure rather than the distal atrial end to achieve complete remodeling.
PubMed: 38933058
DOI: 10.4103/apc.apc_1_24 -
Journal of Clinical Medicine Jun 2024: Arterio-venous fistulas (AVF) are used as first-line access for hemodialysis (HD) in the pediatric population. The aim of this investigation was to describe a...
: Arterio-venous fistulas (AVF) are used as first-line access for hemodialysis (HD) in the pediatric population. The aim of this investigation was to describe a single-center experience in the creation of AVF, together with its patency in children. : This single-center retrospective study included all patients aged ≤18 years with AVFs created between 1993 and 2023. The collected data included patients' demographics, hemodialysis history, intraoperative data, and required reinterventions in order to determine the impact of these variables on primary, primary-assisted, and secondary patency. : Fifty-seven patients were analyzed with a median age of 15 years (range, 7-18 years). Fifty-four forearm and four upper arm fistulas were performed. The median follow-up was 6.9 years (range, 0-23 years). The primary failure rate was 10.5%. The primary patency rate was 67.6%, 53.6%, 51.4%, and 38.1% after 1, 3, 5, and 10 years; primary-assisted patency was 72.9%, 62.8%, 60.6%, and 41.5%; and secondary patency was 87.3%, 81.3%, 76.8%, and 66.6% after 1, 3, 5, and 10 years in the studied population. : AVFs showed an acceptable rate of primary failure and excellent long-term patency. In this context, AVFs are an appropriate option for HD access, especially in pediatric patients.
PubMed: 38930106
DOI: 10.3390/jcm13123577 -
Journal of Clinical Medicine Jun 2024Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly,... (Review)
Review
Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly, there is little consensus on this subject among head and neck specialists. There are two main types of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are also divided into malformations with slow blood flow (veins, lymphatics, capillaries or combined) and malformations with a fast blood flow (arteriovenous malformations and fistula). Vascular tumors like hemangiomas are known for their spontaneous involution with aging, while vascular malformations grow in dimensions with age. It is very important to choose the correct differential diagnosis between cervicofacial hemangiomas and vascular malformations for proper therapy management. Anamnesis and clinical exams help in raising suspicions about the real nature of a cervico-vascular anomaly. Furthermore, imaging brings in-depth details of the anomaly, ranging from ultrasound and contrast CT to MRI scanning and minimally invasive angiography. Angiography with selective embolization is rarely a curative procedure for arteriovenous malformations, being more suitable as a preliminary step before attempted surgical removal. Surgery is clearly necessary when there are aesthetic and functional deficits. Slow-flow vascular malformations present a reduced morbidity, and in cases without involution, the surgical ablation is reserved for the cases with aesthetic dysfunctions or psychological trauma. Lymphatic malformations must undergo surgical ablation when they are associated with mass effects and compression of great vessels or aerial viscera. The prognosis after surgical removal is good, with a low rate of recurrence or morbidity. Fast-flow vascular malformations require a combined approach, with embolization and excision in the next 48 h for safety reasons. Removal may be followed by reconstructive surgery depending on the location and dimensions of the malformation, with a possible secondary recovery of the normal microscopic vessels. Some of the masses may hinder the normal airflow and swallowing. Pathology is the gold standard for confirming the clinical and imaging diagnosis.
PubMed: 38930043
DOI: 10.3390/jcm13123515 -
Journal of Personalized Medicine Jun 2024Intermittent hemodialysis (HD) in high-bleeding-risk patients presents a challenge as circuit anticoagulation using heparin is contraindicated in such cases. Recently,...
Intermittent hemodialysis (HD) in high-bleeding-risk patients presents a challenge as circuit anticoagulation using heparin is contraindicated in such cases. Recently, the use of calcium-free citrate-containing dialysate with calcium supplementation emerged as a viable alternative to heparin-circuit anticoagulation. This is a retrospective, monocentric study to evaluate dialysis efficacy using calcium-free citrate-containing dialysate with calcium reinjection into the venous line in hemodialysis patients at risk of bleeding. A total of 53 patients were analyzed: 52 had a temporary contraindication to systemic anticoagulation (active bleeding or surgical intervention), and 1 chronic HD patient had prolonged bleeding time due to inoperable arteriovenous fistula stenosis. Only 7 out of 79 dialysis sessions performed were prematurely terminated (vascular access dysfunction). The median dialysis time was 240 min (range: 150-300). The chronic dialysis patient had 108 sessions with no premature termination. Frequent monitoring of ionized calcium was performed throughout the dialysis sessions: levels remained stable at T0 and T + 60 min (1.08 ± 0.08 mmol/L) and slightly increased at the end of the dialysis session (1.19 ± 0.13 mmol/L), remaining within normal limits. Target postfilter ionized calcium <0.4 mmol/L was achieved in all sessions (0.31 ± 0.07 mmol/L). There were no cases of symptomatic hypo-/hypercalcemia and no need for calcium infusion rate adjustment throughout the sessions. Hemodialysis with calcium-free citrate-containing dialysate and calcium reinjection into the venous line is efficient and safe in HD patients with contraindications to systemic anticoagulation.
PubMed: 38929882
DOI: 10.3390/jpm14060660