Carotid Bifurcation Geometry as Assessed by Ultrasound is Associated with Early Carotid Atherosclerosis.

BACKGROUND: Atherosclerosis usually develops at geometrically susceptible areas, despite the impact of systemic risk factors on the entire vascular system. The aim of our study was to investigate whether carotid bifurcation geometry as assessed by ultrasound is associated with early carotid atherosclerosis, regardless of the presence of known atherosclerotic risk factors. MATERIAL AND METHODS: A nonrandomized prospective study was undertaken, including subjects of both genders, aged 50-60 years, without known cardiovascular family history, and symptoms and/or signs of cardiovascular disease. Clinical assessment and ultrasound of the carotid bifurcation evaluating geometrical characteristics, ultrasonic biopsy score (UBS), intima-media thickness (IMT), and the presence of plaque were recorded. RESULTS: Two hundred one subjects (95 men/106 women; mean age: 55 years) provided 286 carotid bifurcations associated with atherosclerotic risk factors and 114 without (one poor imaging). While UBS in the right common carotid artery (CCA) was higher in subjects with atherosclerotic risk factors but free of plaque (P = 0.035), larger diameter of the bulb (dBULB) (P < 0.001), lower ratios of internal carotid artery diameter + external carotid artery diameter/diameter of CCA ([dICA + dECA]/dCCA) (P = 0.004), and (dICA2 + dECA2)/dCCA2 (P = 0.025) were independently associated with higher CCA IMT. The presence of plaque among the total 400 carotid bifurcations was associated in the left and right CCA with lower values of bulb diameter/dCCA (dBULB/dCCA) (P = 0.014) and (dICA + dECA)/dCCA (P = 0.001), respectively. Among subjects without atherosclerotic risk factors (n = 114), the presence of plaque in the right CCA was associated with lower values of (dBULB + dECA)/dCCA (P = 0.001) and that in the left with lower values of dBULB/dCCA (P = 0.001). CONCLUSIONS: Different dimensional ratios of the carotid bifurcation assessed by ultrasound are associated with the development of early carotid atherosclerosis independently from the presence of atherosclerotic risk factors. Carotid atherosclerotic process may be side dependent.

Body composition and lung function in children with cystic fibrosis and meconium ileus.

The aim of this study was to explore whether history of meconium ileus (MI) at birth in children and adolescents with cystic fibrosis (CF) adversely affects body composition and lung function in later life. Data of children and adolescents with CF who underwent spirometry and DXA as part of their routine care were analyzed. Associations between MI (explanatory variable) and areal bone mineral density (total body less head-TBLH aBMD), lean tissue mass (LTM), and fat mass (FM) (outcomes) were assessed using general linear models. Potential relationships of TBLH aBMD, LTM, and FM with FEV1 (additional outcome) were also explored. One hundred and one subjects with CF (mean age 14 ± 3 years) were included, 19 (18.8%) of whom had history of MI. Negative associations were demonstrated between history of MI and FEV1 (P = 0.04), TBLH aBMD (P = 0.03), and FM (P < 0.01) but not between history of MI and LTM (P = 0.07) after adjustment for other variables. Lung function was positively associated with TBLH aBMD (P < 0.01) and LTM (P = 0.02) but not with FM (P = 0.20). CONCLUSION: Among children and adolescents with CF, those with history of MI have lower bone mineral density, FM, and lung function. What is Known: • Among children and adolescents with cystic fibrosis, those with history of meconium ileus in the neonatal period are at risk of having lower body mass index percentile and FEV 1 percent predicted. What is New: • Children and adolescents with cystic fibrosis and history of meconium ileus have decreased bone mineral density and fat mass compared to patients without such history. • Lower lung function in children with MI coexists with suboptimal bone mineral density.

A three-dimensional medical imaging model for quantitative assessment of proximal tibia vs. anterior iliac crest cancellous bone.

The proximal tibia metaphysis is a potential alternative donor site for a sufficient amount of cancellous bone, associated with low morbidity and complication rate. We performed an observational computed tomography imaging study to determine the volume of cancellous bone that can be harvested from the proximal tibia compared to the anterior iliac crest, based on an advanced three-dimensional medical imaging model. Results of this study support the findings that a sufficient amount of cancellous bone can be harvested from the proximal tibia compared to the anterior iliac crest. By using a computed tomography imaging technique, the volume of cancellous bone can be precisely determined. However, this study does not show how much bone is safe to remove before increasing the tibial fracture risk.

Iatrogenic pseudoaneurysm of the brachiocephalic artery: a rare complication of Hickman line insertion.

Central venous catheterization is widely used for hemodialysis for patients with renal failure. A number of short and long-term complications have been reported in literature. We describe a rare case of a lethal iatrogenic injury of the brachiocephalic artery (BA) in a 65-year-old woman following subclavian venous catheterization with a Hickman catheter. Contrast-enhanced CT-scan and reconstruction images demonstrated a pseudoaneurysm of the BA. Due to clinical deterioration, the patient underwent urgent sternotomy. Aspects concerning prevention and diagnosis of the above complication are analyzed.

Carotid Bifurcation Geometry and Atherosclerosis.

Hemodynamic changes occurring at the initial segments of the arterial bifurcations appear to play an important role in the development of atherosclerotic plaque. Therefore, arterial geometry might be a potential marker for atherosclerosis. Considerable evidence suggests that geometry can influence local hemodynamics at the carotid bifurcation contributing to the development of atheroma. Bifurcation angle, differences in the area ratios including the flare, proximal curvature, sinus bulb width, and tortuosity of the internal or external carotid artery have been listed as potential contributory elements. These morphometric details have been studied not only in postmortem examination but also with the help of imaging modalities such as ultrasound, digital subtraction angiography, computed tomography angiography, and the assistance of computational models and magnetic resonance angiography. The establishment of certain anatomical and geometrical details in addition to traditional risk factors may help in the identification of patients at high risk of developing carotid artery disease. We reviewed the literature to highlight the evidence on the importance of various geometrical details in the development of carotid atheroma and to suggest areas of future research.

Body composition of patients with Duchenne muscular dystrophy: the Greek experience.

Greece ranks among the first countries suffering from the obesity epidemic globally. The aim of the study was to evaluate body composition in Greek patients with Duchenne muscular dystrophy (DMD). We hypothesized that able-bodied patients would not differ from controls, in terms of adiposity, based on clinical observations during everyday practice. STUDY DESIGN: Cross-sectional study of steroid-dependent DMD subjects, who underwent dual-energy X-ray absorptiometry and laboratory metabolic bone profile evaluation. Forty-two patients and thirty-one controls were studied. Overall, DMD subjects were shorter (height Z-score = -1.4, p = 0.01). Their bone mineral density (BMD) was low (lumbar spine BMD Z-score = -1.2, p < 0.01, subcranial total body BMD Z-score = -1.8, p < 0.01). Lean tissue mass (LTM) was also decreased (LTM Z-score = -2.2, p < 0.01). The above findings were more pronounced in adolescence. Regarding adiposity, increased fat mass (FM) was found only in pubertal DMD patients (FM Z-score = 1.4, p < 0.01), whereas prepubertal, able-bodied patients did not differ from controls, thus confirming the initial hypothesis. Finally, 65 % of DMD subjects had increased bone resorption markers and 57 % had suboptimal vitamin D levels. The importance of using native population as controls for body composition analysis is highlighted. In Greece, abnormal body composition in DMD patients is more striking when loss of ambulation occurs and not during the prepubertal period, due to the concurrent presence of obesity in the pediatric population. Thus, adolescents with this neuromuscular disorder should be targeted toward prompt lifestyle interventions.

Integrating imaging techniques in lower limb microsurgical reconstruction: focusing on ultrasonography versus computed tomography angiography.

Recent developments in the field of biomedical imaging have facilitated the use of various imaging techniques as adjunctive tools in microsurgical lower limb reconstructions. Frequently-used imaging modalities in reconstructive microsurgery are colour-Doppler ultrasound and computed tomography angiography. Here, we present basic principles of the above applied techniques and analyze the surgical rationale of integrating imaging techniques in lower limb reconstruction.

Is routine ultrasound examination of the gallbladder justified in critical care patients?

Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6 ± 2.8 years; APACHE II score 21.3 ± 0.9; mean ICU stay 35.9 ± 4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

Inferior thyroid artery pseudoaneurysm caused by blunt trauma.

Injury to the inferior thyroid artery (ITA) is an extremely rare complication of blunt neck trauma. The subtle initial clinical presentation and the potential life-threatening sequelae make it a diagnostic and therapeutic challenge. We report a case of an ITA pseudoaneurysm caused by seat-belt injury. Imaging findings and successful treatment with coil embolization are described. The role of noninvasive imaging techniques in establishing the diagnosis is emphasized.