Four-Vessel Umbilical Cord: Supernumerary Right Umbilical Vein With No Associated Congenital Anomalies.

A four-vessel umbilical cord is a rare anomaly that can occur with abnormal persistence of the caudal portion of the vessel. Although supernumerary vessels can present as an isolated finding, they are known to be associated with multiple significant congenital anomalies. Ectopia cordis, pulmonary stenosis, cleft lip, cleft palate, situs inversus, tetralogy of Fallot, and gastroschisis are some anomalies associated with four-vessel cords. This is a case of a 22-year-old multigravida with a four-vessel umbilical cord initially found on sonography. The patient was sent to Maternal Fetal Medicine for evaluation. It was determined that the patient had a right supernumerary umbilical vein that did not require further workup. The patient presented to labor and delivery at 36 weeks and five days with regular contractions. After normal vaginal delivery without complications, the four-vessel-umbilical cord was visualized and confirmed by pathology. The patient and neonate both did well with no complications.

Comparison of Clinical Characteristics between Rubella Virus and Cytomegalovirus Associated Chronic Unilateral Anterior Uveitis.

PURPOSE: To identify the clinical characteristics that may predict the diagnosis of Rubella virus (RV) or Cytomegalovirus (CMV) among cases of chronic treatment resistant or steroid dependent unilateral anterior uveitis (AU). METHODS: Thirty-three consecutive patients with a diagnosis of CMV and 32 patients with RV chronic AU were enrolled. The respective frequency of certain demographic and clinical characteristics was compared between the two groups. RESULTS: The presence of abnormal vessels in the anterior chamber angle (75% and 6.1%, respectively, p < .001), vitritis (68.8%-12.1%, p < .001), iris heterochromia (40.6%-15.2%, p = .022) and iris nodules (21.9%-3%, p = .027) were more common among RV AU. Conversely, intraocular pressure greater than 26 mmHg was more commonly encountered in CMV associated AU (63.6%-15.6%, respectively, p < .001) and large keratic precipitates were detected only in CMV-associated AU. CONCLUSIONS: RV- and CMV-induced chronic AU differ significantly in the prevalence of specific clinical characteristics.

Alteration of chronic inflammatory status by transarterial embolization in frozen shoulder evaluated by fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography.

BACKGROUND: Frozen shoulder (FS) is speculated to have an inflammatory etiology. On angiography, abnormal angiogenesis is observed around the affected shoulder, suggesting a possible source of inflammation and pain. The effectiveness and safety of transarterial embolization (TAE) targeting abnormally proliferating blood vessels have been reported. This study investigated changes in chronic inflammatory and hypoxic status before and after TAE in FS by [18F]-fluoro-2-deoxyglucose (FDG) positron-emission tomography/computed tomography as a possible mechanism of the therapeutic response to TAE. METHODS: Fifteen patients with unilateral FS, persistent for more than 6 months, who were refractory to conservative treatments, underwent TAE using the temporary embolic agent imipenem/cilastatin. Patients underwent positron-emission tomography/computed tomography with FDG (as a biomarker of inflammation) before and 8 weeks after TAE. Regional uptake was evaluated by the maximum standardized uptake value. The lesion-side-to-(contralateral-) normal-side uptake ratio was also calculated. Pain and functional scales, range-of-motion, and laboratory tests, including white blood cell, C-reactive protein, interleukin 6, vascular endothelial growth factor, and tumor necrosis factor α were evaluated. RESULTS: On FDG-PET, the average maximum standardized uptake value of the lesion-side was significantly greater than that of the normal-side (maximum standardized uptake value before TAE: 3.11 ± 1.25 vs 1.95 ± 1.15, P = .0001; 8-weeks post-TAE: 2.36 ± 0.74 vs 1.78 ± 0.69, P = .0002). The mean lesion-side-to-(contralateral-) normal-side uptake ratios before TAE (1.71 ± 0.60) decreased after TAE (1.37 ± 0.29, P = .011). The decrease of FDG uptake (-21.1 ± 12.2%) showed a significant correlation with the change in the pain scale score (r = -0.56, P = .039) and extension score (r = -0.59, P = .026). CONCLUSION: Chronic inflammation in FS, as demonstrated by FDG uptake, was decreased after TAE. Thus, chronic inflammation is likely to be an underlying mechanism that should be targeted for symptomatic improvement of frozen shoulder.

Congenital Unilateral Absence of the Internal Carotid Artery Associated with Aneurysms of Different Arteries: A Review.

There are 466 cases of absent unilateral (398) and bilateral (68) internal carotid artery (ICA) published in online books, abstracts, and original articles from 2020 to 2021. Of the 398 cases of absent unilateral ICA, 95 were associated with aneurysms. The analysis of these cases includes age, nationality and gender, location of aneurysm(s), description, and scheme of carotid-vertebrobasilar angioarchitecture mode in the brain base, as well as hypothesis on the embryonic background of accompanying vascular variations and abnormalities. The calculated ratio between the number of absent unilateral ICA cases and the number of absent bilateral ICA cases is 5.8:1. The ratio between the total number of cases of absent unilateral ICA and those associated with aneurysms is 4.2:1. The association between the posterior communicating middle cerebral anastomosis and intercavernous (trans-sellar or intercarotid) channel with the absence of both anterior cerebral and anterior communicating arteries is common. More than half of the cases with aneurysms are located at the anterior segment vessels of the cerebral arterial circle. This review is based on the description and explanation of embryology and morphology of absent unilateral ICA with aneurysms, which would be a significant contribution to published literature on this topic, especially due to the fact that nothing similar has been published since 1957.

Gastrointestinal Vascular Malformations in Patients with Turner's Syndrome: A Systematic Review of Case Reports.

BACKGROUND/AIM: There is a paucity of data on gastrointestinal (GI) vascular abnormalities in patients with Turner's syndrome (TS). Therefore, this literature review aimed to characterize the nature of GI vascular malformations in patients with TS, their localization in the GI tract, and their clinical and laboratory manifestations. METHODS: A systematic search for articles was conducted using Medline and Embase (until August 2017). A manual search of the references of the included papers was performed to identify any potential additional references. We also conducted a retrospective chart review of all patients with TS and GI bleeding who were hospitalized at our institution. RESULTS: A total of 29 articles published between 1947 and 2015 that described 39 cases were reviewed. Additionally, we included 2 patients who were hospitalized at our institution. The median age of patients with TS was 15 years (range: 0.1-57 years). Iron deficiency anaemia (35/40), haematochezia (15/37), and melaena (14/36) were the most common symptoms. Abnormal GI vessels occurred throughout the entire bowel, with a predilection for the small intestine (72%, 29/40). The most common abnormal vessels (65%, 24/37) were telangiectasias and dilated veins. CONCLUSION: Telangiectasias and dilated veins of the small intestine were the most commonly seen abnormal GI vessels in patients with TS.

Additive Value of 3T 3D CISS Imaging to Conventional MRI for Assessing the Abnormal Vessels of Spinal Dural Arteriovenous Fistulae.

INTRODUCTION: We investigated the additive value of the 3T 3D constructive interference in steady state (CISS) sequence to conventional MRI for the evaluation of spinal dural arteriovenous fistulae (SDAVF). MATERIALS AND METHODS: We included 16 consecutive patients (15 men, 1 woman; age range 42-81 years; mean 64 years) with SDAVF who underwent 3T MRI and digital subtraction angiography (DSA) before treatment. Two neuroradiologists independently evaluated the presence of abnormal vessels on 3D CISS-, T2- and T1-weighted images (T1WI, T2WI), and contrast-enhanced T1WI using a 3-point grading system. Interobserver agreement was assessed by calculating the κ coefficient. RESULTS: The SDAVF site was the cervical region in one patient, the thoracic region in 12 patients, the lumbar region in two, and the sacral region in one. For the visualization of abnormal vessels, the mean score was significantly higher for 3D CISS than the other sequences (P < 0.05). In 12 of 16 cases (75%) both readers made definite positive findings on additional 3D-CISS images. Interobserver agreement was excellent for 3D CISS images (κ = 1.0), good for T1WI (κ = 0.78; 95% confidence interval [CI] 0.54-1.00) and T2WI (κ = 0.74; 95% CI 0.48-1.00) and moderate for contrast-enhanced T1WI (CET1WI) (κ = 0.50; 95% CI 0.21-0.80). CONCLUSION: For the assessment of abnormal vessels of SDAVF, the 3T 3D CISS sequence adds value to conventional MRI.

Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up.

BACKGROUND: Abnormal vessels and accompanying nerves are possible sources of pain with lateral epicondylitis. The purpose of this study was to describe the safety and efficacy of transcatheter arterial embolization (TAE) for lateral epicondylitis resistant to conservative treatment. METHODS: This prospective study was conducted in 24 patients with lateral epicondylitis resistant to conservative treatments for more than 3 months, with a symptom duration longer than 6 months, and with moderate to severe pain who were treated with TAE between March 2013 and October 2014. Two patients were lost to follow-up, and the remaining 22 patients were followed up for 2 years after TAE. RESULTS: Abnormal vessels were identified in all of the patients. No major adverse events were observed. The Quick Disabilities of the Arm, Shoulder and Hand scores at baseline significantly decreased at 1, 3, 6, and 24 months after treatment (50.8 vs 23.4, 8.3, 5.3, and 2.7, respectively; all P < .001). There was a statistically significant (P < .001) change from baseline to the last observed value in all of the clinical parameters, including visual analog scale pain score, Patient-Rated Tennis Elbow Evaluation score, and pain-free grip strength. Magnetic resonance images obtained 2 years after TAE showed an improvement in tendinosis and tear scores compared with baseline, and no patients showed bone marrow necrosis, obvious cartilage loss, or muscle atrophy. CONCLUSION: TAE could be one possible treatment option for patients with lateral epicondylitis that fails to improve with conservative treatments.

Short-term results of transcatheter arterial embolization for abnormal neovessels in patients with adhesive capsulitis: a pilot study.

BACKGROUND: Neovessels and accompanying nerves are possible sources of pain. We postulated that transcatheter arterial embolization of abnormal neovessels would relieve pain and symptoms in patients with adhesive capsulitis. METHODS: Adhesive capsulitis was treated by transcatheter arterial embolization in 7 patients. Adverse events, changes in visual analog scale scores for night pain and overall shoulder pain, and changes in range of motion and American Shoulder and Elbow Surgeons scores were assessed at 1 week and at 1, 3, and 6 months after the procedure. RESULTS: Abnormal neovessels were identified at the rotator interval in all patients. No major or minor adverse events were associated with the procedures. Transcatheter arterial embolization rapidly decreased nighttime pain scores from 67 ± 14 mm to 27 ± 14 mm at 1 week after the procedure, with further improvement at 1 and 6 months (6 ± 8 mm and 2 ± 5 mm, respectively). The American Shoulder and Elbow Surgeons score significantly improved from 17.8 ± 4.5 to 39.8 ± 12.0, 64.3 ± 13.9, and 76.2 ± 4.4 at 1, 3, and 6 months, respectively. CONCLUSION: All patients with adhesive capsulitis had abnormal neovessels at the rotator interval. Transcatheter arterial embolization was feasible, relieved unrelenting pain, and restored shoulder function.