-
Pediatric Cardiology Jun 2024Pediatric patients with coronary artery lesions (CALs) after Kawasaki disease (KD) may be complicated with myocardial ischemia. Although previous studies in adults have...
Pediatric patients with coronary artery lesions (CALs) after Kawasaki disease (KD) may be complicated with myocardial ischemia. Although previous studies in adults have proven the diagnostic value of Tc-MIBI myocardial perfusion imaging (MPI) for ischemic heart disease, its feasibility and accuracy in this pediatric population remain uncertain. In this retrospective study, we collected data of 177 pediatric patients (Age range: 6 months to 14 years) who had undergone MPI and coronary artery angiography (CAG) between July 2019 and February 2023. Using the positive result of CAG as the reference standard of myocardial ischemia, we compared the results of Tc-MIBI MPI with other non-invasive examinations, including cardiac magnetic resonance imaging (CMRI), echocardiogram, and comprehensive electrocardiogram-related examinations. All patients finished adenosine triphosphate stress MPI without major side effects. The sensitivity of MPI was 79.17%, which was greater than CMRI and echocardiogram (P < 0.05). The negative predictive value and the accuracy of MPI were 89.9% and 71.75%, indicating the advantages over others. Composite monitoring strategy of MPI and CMRI effectively improved the diagnostic performance (P < 0.001). In 4 cases diagnosed with myocardial ischemia by "MPI + CMRI," despite the absence of significant stenosis, multiple giant coronary artery aneurysms (GCAA) were all observed in CAG. Tc-MIBI MPI is the preferred non-invasive examination for detecting myocardial ischemia in pediatric patients with CAL after KD. When combined with CMRI, it can enhance diagnostic accuracy. Multiple GCAAs without stenosis may be an isolated risk factor of myocardial ischemia.
PubMed: 38940825
DOI: 10.1007/s00246-024-03545-2 -
Alternative Therapies in Health and... Jun 2024Cerebral aneurysm can rupture a blood vessel and cause bleeding in the brain. Microsurgical clipping of the tumor neck has been reported to be effective in treating...
Clinical Efficacy of Early Microsurgical Clipping of Tumor Neck in the Treatment of Cerebral Aneurysm Rupture and Bleeding and Its Impact on Oxidative Stress Response and Prognosis of Patients.
BACKGROUND
Cerebral aneurysm can rupture a blood vessel and cause bleeding in the brain. Microsurgical clipping of the tumor neck has been reported to be effective in treating cerebral aneurysm rupture and bleeding.
OBJECTIVE
This research attempted to clarify the clinical efficacy of early microsurgical clipping of tumor neck for treating cerebral aneurysm rupture and bleeding, and its impact on prognosis of patients.
DESIGN
This was a retrospective study.
SETTING
This study was carried out in the Department of Neurosurgery, The Yancheng School of Clinical Medicine of Nanjing Medical University, Yancheng Third People's Hospital.
UNLABELLED
One hundred patients with cerebral aneurysm rupture and bleeding patients aged from 23 to 70 years old, and diagnosed with CA rupture and bleeding through imaging examinations such as CT angiography (CTA) and digital subtraction angiography (DSA), and there was spontaneous subarachnoid hemorrhage treated in our hospital from November 2020 to November 2022 were selected and divided into an experimental group (n=25) and a control group (n=25) according to surgical time.
INTERVENTIONS
All patients underwent microsurgical clipping of the tumor neck for therapy. Under microscope monitoring, the temporal and frontal lobes of the patient were separated, and the tumor body was selected in the internal carotid artery and cerebral artery. After the tumor neck of the patient was exposed, the artery supplying blood was clipped and appropriate tumor clips were selected. The control group chose to undergo surgery 72 h after the onset of cerebral aneurysm rupture and bleeding, while the experimental group chose to undergo complete surgery within 72 h after the onset of cerebral aneurysm rupture and bleeding. After surgery, targeted treatment were given to patients in 2 groups based on their physical condition, such as dehydration to reduce intracranial pressure, anti-vasospasm, anti-infection, monitoring of neurological changes, and monitoring of vital signs. Cerebral angiography should also be performed for reexamination.
PRIMARY OUTCOME MEASURES
(1) incidence of complications (2) cognitive function scores assessed by Montreal Cognitive Assessment (MoCA) (3) prognosis assessed by Glasgow Outcome Scale (GOS) (4) surgical indicators (5) oxidative stress response and (6) quality of life assessed by short form 36 health survey questionnaire (SF-36).
RESULTS
Compared to the control group, the incidence of complications in the experimental group exhibited depletion (24.0% vs 8.0%) (P < .05), the prognosis in the experimental group exhibited elevation [(2.23±0.45) points vs (4.12±0.3) points] (P < .05), the hospitalization time in the experimental group exhibited depletion [(15.69±1.21) d vs (11.31±0.65) d] (P < .05), the nomination, abstraction, language, orientation, attention, delayed recall and visual and executive function scores and total scores in experimental group exhibited elevation [(2.69±0.52 points, 2.07±0.63 points, 3.02±0.44 points, 2.45±0.51 points, 3.12±0.36 points, 2.14±0.75 points, 3.15±0.64 points and 17.24±2.15 points) vs (4.25±0.65 points, 3.88±1.08 points, 5.03±0.73 points, 3.34±0.72 points, 4.05±0.66 points, 3.85±0.33 points, 5.02±1.04 points and 26.89±1.33 points)] (P < .05), serum levels of oxidative stress-related indicators in the experimental group exhibited depletion [(462.14±48.47 ng/mL, 281.14±36.44 ng/mL and 1.62±0.12 nmol/mL) vs (365.58±44.56 ng/mL, 201.51±34.47 ng/mL and 1.15±0.1 nmol/mL)](P < .05) and the quality of life in experimental group exhibited elevation [(73.65±7.43 points, 72.24±7.23 points, 73.25±7.36 points, 70.24±7.05 points and 72.16±7.25 points) vs (81.25±8.14 points, 80.87±8.09 points, 81.43±8.15 points, 80.57±8.07 points and 81.32±8.14 points)] (P < .05).
CONCLUSION
Early microsurgical clipping of the tumor neck can downregulate risk of complications and cognitive impairment of cerebral aneurysm rupture and bleeding patients, which is worthy for clinical application.
PubMed: 38940784
DOI: No ID Found -
Developmental Medicine and Child... Jun 2024Cranial ultrasound reliably diagnoses many neonatal brain disorders. Adding Doppler imaging expands the spectrum by providing information on the status of the... (Review)
Review
Cranial ultrasound reliably diagnoses many neonatal brain disorders. Adding Doppler imaging expands the spectrum by providing information on the status of the vasculature and haemodynamics that may guide further diagnostic and clinical management. Doppler imaging may identify neonates with congenital or acquired vascular abnormalities such as perinatal stroke, sinuvenous thrombosis, vein of Galen malformation, dural sinus malformation, sinus pericranii, and developmental venous anomaly. These entities may need further investigation with complementary imaging modalities such as magnetic resonance imaging and magnetic resonance angiography, or conventional angiography. This review aims to help clinicians to improve their Doppler sonography knowledge and skills in order to use this helpful tool in neonates with neurological symptoms or suspected cerebral vascular abnormalities admitted to the neonatal intensive care unit.
PubMed: 38940604
DOI: 10.1111/dmcn.15998 -
Anatolian Journal of Cardiology Jul 2024
Topics: Humans; Radial Artery; Male; Diagnosis, Differential; Coronary Angiography; Middle Aged
PubMed: 38940408
DOI: 10.14744/AnatolJCardiol.2024.7 -
Turkish Journal of Ophthalmology Jun 2024Yasunari nodules are choroidal lesions observed in patients diagnosed with neurofibromatosis type 1 (NF-1) and characterized by relatively irregular dome-shaped,...
OBJECTIVES
Yasunari nodules are choroidal lesions observed in patients diagnosed with neurofibromatosis type 1 (NF-1) and characterized by relatively irregular dome-shaped, plaque-like, or patchy boundaries. The present study examines the multimodal imaging characteristics of Yasunari nodules and their value in the diagnosis of NF-1.
MATERIALS AND METHODS
Medical records including optical coherence tomography (OCT), enhanced depth imaging OCT, infrared reflectance (IR) imaging, OCT angiography, and color fundus images of NF-1 patients who were examined at the Department of Ophthalmology in Dokuz Eylül University Faculty of Medicine between January 2022 and December 2023 were retrospectively reviewed for the presence of Yasunari nodules.
RESULTS
A total of 54 eyes of 27 patients were included in the study. At least one choroidal nodule was detected on IR imaging in 52 eyes (96.3%). In 31 (72.1%) of the 43 eyes (79.6%) with available high-quality OCT angiography images, choroidal nodules were observed as areas showing a flow deficit in the choriocapillaris layer. Of the total 54 eyes included, Lisch nodules without choroidal nodules were observed in 2 eyes (3.7%). In 16 eyes (29.6%), Lisch nodules were not detected despite the presence of choroidal nodules. Both Lisch nodules and choroidal nodules were detected in the other 36 eyes (66.7%).
CONCLUSION
Yasunari nodules are frequently observed in NF-1 cases and can be easily detected with multimodal imaging techniques, especially IR imaging. The ability to visualize choroidal nodules before the appearance of Lisch nodules demonstrates the importance of Yasunari nodules in the diagnosis of NF-1.
Topics: Humans; Neurofibromatosis 1; Female; Male; Tomography, Optical Coherence; Retrospective Studies; Multimodal Imaging; Adult; Fluorescein Angiography; Adolescent; Middle Aged; Young Adult; Child; Choroid; Choroid Diseases; Fundus Oculi
PubMed: 38940356
DOI: 10.4274/tjo.galenos.2024.48017 -
Journal of Pediatric Ophthalmology and... Jun 2024To evaluate the structural and microvascular changes in the retina and choroid after strabismus surgery.
PURPOSE
To evaluate the structural and microvascular changes in the retina and choroid after strabismus surgery.
METHODS
The study included 44 eyes from 44 patients who underwent strabismus surgery between August 2020 and December 2021. Among these patients, 9 (20%) underwent horizontal one-muscle surgery, 27 (61%) underwent horizontal two-muscle surgery, and 8 (18%) underwent inferior oblique muscle anteriorization surgery. Optical coherence tomography angiography scans were conducted preoperatively and at 1 day, 1 week, 1 month, and 3 months postoperatively.
RESULTS
The outer retinal blood flow showed a significant increase at 1 day postoperatively in horizontal two-muscle and inferior oblique muscle anteriorization surgery, whereas no significant difference was observed between periods in horizontal one-muscle surgery ( = .007). Choriocapillaris blood flow exhibited a significant increase at 1 day and 1 month postoperatively compared to the preoperative period ( < .001). Whole image superficial capillary plexus vascular density was significantly lower at 1 day postoperatively than preoperatively and 1 and 3 months postoperatively ( < .001). Whole image deep capillary plexus vascular density was significantly lower at 1 day than at 1 month postoperatively ( = .002).
CONCLUSIONS
Following strabismus surgery, temporary changes in the hemodynamic microcirculation in the retina and choroid are observed. A transient decrease in retinal artery blood supply may be noticed, possibly attributed to the reduced anterior segment blood supply. .
PubMed: 38940311
DOI: 10.3928/01913913-20240508-04 -
Veterinary Radiology & Ultrasound : the... Jun 2024A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary...
A 1-year-old Miniature Horse filly was presented for chronic lethargy and hyporexia. Elevated liver enzymes, bile acids, and ammonia were noted on bloodwork. The primary differential diagnosis was a portosystemic shunt (PSS). Three-phase computed tomographic angiography findings were consistent with a transhepatic portosystemic shunt. Percutaneous liver biopsy confirmed severe diffuse hepatic changes, most likely due to chronic pyrrolizidine alkaloid toxicosis, and medical management was elected. Based on an extensive literature review, this is the first report of a transhepatic portosystemic collateral vessel in a horse. Computed tomographic angiography is feasible and useful for the diagnosis of PSS in miniature horses.
PubMed: 38940068
DOI: 10.1111/vru.13401 -
Circulation. Genomic and Precision... Jun 2024Clonal hematopoiesis of indeterminate potential (CHIP) occurs due to acquired mutations in bone marrow progenitor cells. CHIP confers a 2-fold risk of atherosclerotic...
BACKGROUND
Clonal hematopoiesis of indeterminate potential (CHIP) occurs due to acquired mutations in bone marrow progenitor cells. CHIP confers a 2-fold risk of atherosclerotic cardiovascular disease. However, there are limited data regarding specific cardiovascular phenotypes. The purpose of this study was to define the coronary artery disease phenotype of the CHIP population-based on coronary angiography.
METHODS
We recruited 1142 patients from the Vanderbilt University Medical Center cardiac catheterization laboratory and performed DNA sequencing to determine CHIP status. Multivariable logistic regression models and proportional odds models were used to assess the association between CHIP status and angiography phenotypes.
RESULTS
We found that 18.4% of patients undergoing coronary angiography had a CHIP mutation. Those with CHIP had a higher risk of having obstructive left main (odds ratio, 2.44 [95% CI, 1.40-4.27]; =0.0018) and left anterior descending (odds ratio, 1.59 [1.12-2.24]; =0.0092) coronary artery disease compared with non-CHIP carriers. We additionally found that a specific CHIP mutation, ten eleven translocase 2 ), has a larger effect size on left main stenosis compared with other CHIP mutations.
CONCLUSIONS
This is the first invasive assessment of coronary artery disease in CHIP and offers a description of a specific atherosclerotic phenotype in CHIP wherein there is an increased risk of obstructive left main and left anterior descending artery stenosis, especially among mutation carriers. This serves as a basis for understanding enhanced morbidity and mortality in CHIP.
PubMed: 38939956
DOI: 10.1161/CIRCGEN.123.004415 -
Clinical Case Reports Jul 2024Blunt chest trauma caused ST-segment elevation myocardial infarction. Diagnosis of intramural hematoma (IMH) using computed tomography was confirmed using...
Blunt chest trauma caused ST-segment elevation myocardial infarction. Diagnosis of intramural hematoma (IMH) using computed tomography was confirmed using electrocardiography, cardiac marker tests, and subsequent coronary angiography. After conservative treatment, the hematoma was completely resolved 1 year later. Differentiating IMH from other arterial injuries is critical for appropriate management.
PubMed: 38939554
DOI: 10.1002/ccr3.8988 -
JACC. Advances Feb 2024Type 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences...
BACKGROUND
Type 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this population.
OBJECTIVES
The purpose of this study was to evaluate sex-based disease differences in type 2 MI among patients evaluated with coronary computed tomography angiography and fractional flow reserve.
METHODS
In a single-center, prospective study, patients with strictly adjudicated type 2 MI underwent coronary computed tomography angiography with fractional flow reserve.
RESULTS
Among 50 study participants enrolled, 50% were women. A similar mix of MI precipitants was present in both sexes. ST-segment depression was more common in women (64% vs 32%), while men were more likely to have T wave inversion (68% vs 36%). Women and men had comparable coronary artery calcium scores (median: 152 [Q1, Q3: 45, 762] vs 234 [Q1, Q3: 56, 422]). Prevalence of any CAD (84% vs 100%), obstructive CAD (24% vs 28%), and hemodynamically significant focal stenosis (20% vs 32%) were similar between sexes. Total plaque volume was similar between sexes, but women had significantly lower levels of low-attenuation plaque (median: 3 [Q1, Q3: 1, 7] vs 9 [Q1, Q3: 3, 14]).
CONCLUSIONS
Among patients with type 2 MI, prevalence of any CAD and obstructive CAD did not differ according to sex. Total plaque volume was similar between sexes, but women had a lower volume of low-attenuation plaque (DEFINing the PrEvalence and Characteristics of Coronary Artery Disease Among Patients With TYPE 2 Myocardial Infarction Using CT-FFR [DEFINE TYPE2MI]; NCT04864119).
PubMed: 38939381
DOI: 10.1016/j.jacadv.2023.100795