The effect of living at high altitude on carotid intima-media thickness in the elderly: a comparative study.

BACKGROUND: Previous studies have shown that high altitude may have a protective effect on cardiovascular diseases. However, the effects of high altitude on carotid atherosclerosis have been less evidenced. PURPOSE: To compare the effect of altitude on atherosclerosis by using carotid artery ultrasonography (CAU) findings. MATERIAL AND METHODS: A total of 180 patients aged >60 years, who had proper recorded data of ultrasonography and blood tests, and who resided in the same city for at least five years were included. Patients with anemia, hyperlipidemia, diabetes mellitus, hypertension, and those who did not meet the inclusion criteria were excluded. Patients were divided into two groups: high altitude group (HAG) and sea level group (SLG). CAU findings of each patient-including common carotid artery intima-media thickness (CIMT) ≥1 mm and < 1 mm, internal carotid artery (ICA) stenosis rate, and plaque types-were recorded and compared between the two groups. Blood test parameters and lipid profiles were additionally recorded. RESULTS: Prevalence of patients with CIMT ≥1 mm was significantly higher in the SLG (SLG: 50%, HAG: 15.6%; P < 0.001). Carotid stenosis was found to be significantly different in both groups (HAG: 9.96% ± 23.27%, SLG: 29.83% ± 23.30%; P < 0.001). RBC, HGB, HDL values, and HDL/LDL ratio were found to be significantly higher in the HAG (P < 0.001) whereas LDL, TG, and TC values were significantly higher in the SLG (P < 0.001). CONCLUSIONS: People who reside at high altitudes have significantly lower rate of carotid stenosis, lower CIMT values, and less atherogenic lipid profile values, all of which indicate protective effect of high altitude on atherosclerosis.

Correlation Between Semen Analysis Parameters and Diffusion-Weighted Magnetic Resonance Imaging of the Testicles in Patients With Varicocele: A Pilot Study.

PURPOSE: The aims of this study were to evaluate using testicle apparent diffusion coefficient (ADC) values in patients with varicocele and compare them with those of healthy individuals, to identify an optimal ADC threshold level to predict abnormal semen analysis using diffusion-weighted imaging. MATERIALS AND METHODS: Thirty-one patients with the diagnosis of varicocele and 20 healthy controls were enrolled in the study. All subjects underwent testicle diffusion-weighted imaging at b values of 0, 400, and 800 s/mm and semen analysis. Student t tests were used to compare continuous variables between 2 groups. Testicle ADC values were correlated with semen analysis parameters. The relationship between ADC values and impaired semen analysis parameters was evaluated using Pearson correlation coefficient analysis. Receiver operating characteristic curves were formed. Cut-off values for ADC, sensitivity, and specificity values were measured. RESULTS: There was a negative correlation between mean ADC values and plexus pampiniformis vein diameter (r = -0.467, P < 0.001) and a positive correlation between mean ADC values and sperm count (r = 0.838, P < 0.001) as well as sperm morphology (r = 0.548, P < 0.05). Sensitivity values of 94.3% and 86.6% and specificity values of 87.5% and 43.8% were determined for the best cut-off ADC values in diagnosing the sperm count and morphology, respectively (area under the curve, 0.961 and 0.781). CONCLUSIONS: Decreased testicular ADC values in patients with varicocele are significantly correlated with semen parameters. This method may be used to determine the degree of testicular parenchymal destruction. In addition, testicular ADC cut-off values might be useful in dyspermia patients for the management of patients with varicocele.

Giant Coronary-Pulmonary Artery Fistula Incidentally Detected in a Patient Presenting With Acute Inferior Myocardial Infarction.

Coronary artery fistulas are abnormal connections between the coronary arteries and the heart or other surrounding vascular structures. Although they are usually congenital, they can also occur iatrogenically or due to trauma. They are usually asymptomatic, but they can cause serious and even fatal complications. These complications include myocardial infarction, embolism, thrombosis, arrhythmia, and rupture. In a 54-year-old woman admitted to the emergency department with an acute inferior myocardial infarction, a giant coronary-pulmonary artery fistula was detected on angiography. The fistula could not be closed percutaneously, and computed tomography angiography (CTA) revealed extensive aneurysms and diffuse calcifications. Large fistulas should be closed due to the risk of rupture. Small fistulas should be detected by CTA, and radiologists should be familiar with the imaging features.

Factors Affecting Carotid Artery Stenosis in the Elderly Living at High Altitudes.

BACKGROUND: Factors affecting carotid artery stenosis have been generally investigated. However, considering the protective effect of altitude, studies on elderly individuals at high altitudes are few. Our aim is to investigate the systematic adaptive changes caused by high-altitude exposure through the causes of carotid artery stenosis. MATERIALS AND METHODS: Carotid Doppler ultrasound was performed on 250 patients over the age of 50 years. The patients' age, gender, height, weight, smoking history, place of residence, and presence of comorbidities were questioned. Those with diabetes, hypertension, hyperlipidemia, and coronary disease were excluded from the study. Those who did not reside at high altitudes were excluded from the study. One hundred and thirty-five patients were included in the study. Carotid artery Doppler findings and biochemical parameters were recorded. Factors affecting stenosis in the carotid arteries were compared. RESULTS: In our study, the factors affecting carotid stenosis were determined to be age, gender, presence of plaque, plaque type, and mean carotid intima-media thickness (CIMT). The mean CIMT of the patients was calculated as 0.71±0.14 mm. The mean CIMT measurement level was significantly higher in patients with plaque in the carotid artery (p<0.05). According to receiver operating characteristic curves, CIMT values higher than 0.72 mm increase plaque and stenosis formation in the common carotid artery (CCA) and internal carotid artery (ICA) in elderly people living at high altitudes (p<0.05, area under the curve [AUC]: 0.71-0.83). CONCLUSIONS: The most important factors affecting carotid stenosis in individuals living at high altitudes are age, gender, CIMT, plaque, and plaque type. When soft plaques were detected, the risk of stenosis was found to be higher than in calcific plaques. Additionally, the number of factors affecting stenosis was greater on the left (ICA). This suggests that the left carotid system is more vulnerable. It can be said that in elderly individuals living at high altitudes, a CIMT higher than 0.72 mm is a cutoff value in the presence of plaque and stenosis in the carotid arteries.

Comparison of Clopidogrel, Prasugrel and Ticagrelor Response of Patients by PFA-100-Innovance Test Results.

Devices such as stents and flow diverters require the use of safe and fast antiplatelet therapy. We aimed to compare the responses to clopidogrel, prasugrel, and ticagrelor by assessing the Platelet Function Analysis (PFA-100)-Innovance test results of patients undergoing endovascular stenting to determine their resistance rates. Sixty-one women and 55 men, aged 18-87 years, were included in this study. Patients were divided into three groups: clopidogrel treatment, prasugrel treatment, and ticagrelor treatment. The systemic diseases of the patients, especially hypertension and diabetes, were recorded. The test results were evaluated according to the results for the collagen/epinephrine (COL-EPI), collagen/adenosine (COL-ADP), and P2Y results. The PFA-100-Innovance results for COL-EPI and P2Y were significantly higher for patients treated with prasugrel and ticagrelor compared with patients treated with clopidogrel (COL-EPI, p = 0.001; P2Y, p = 0.001). Clopidogrel resistance was identified in 31 patients (26.7%), and prasugrel resistance was identified in 4 patients (3.4%). Ticagrelor resistance was not detected. Therefore, 30.1% of patients were classified as drug-resistant. Perioperative bleeding was not detected in any patient. Hypertension was the most common disease recorded for patients being treated for cerebral aneurysm, and diabetes was the most common disease recorded for patients who underwent peripheral artery stenting (p = 0.002). Potent antiplatelet agents, such as prasugrel and ticagrelor, have a low rate of resistance but are associated with an increased bleeding risk. Thus, the choice of a suitable drug during the treatment window remains a critical factor when determining treatment strategies.

Type 1C Multiple Symmetrical Lipomatosis: A Cause of Misdiagnosis in Females.

Multiple symmetrical lipomatosis (MSL) is a disease that causes symmetrical fat deposits in the neck, shoulders, and upper trunk. It is more common in the neck area in men who consume alcohol. The male-to-female ratio varies from 15:1 to 30:1. Madelung's disease has been reported in a small number of female patients who do not consume alcohol. Pseudoathletic appearance (MSL type 1C) is rare and causes misdiagnosis. We would like to present a 50-year-old woman with an athletic appearance who had fat deposits on her shoulders and upper chest. After excluding obesity and Cushing's syndrome, which were initially considered, we aimed to remind people of this entity that causes symmetrical fat deposits in the upper trunk in females.

Imaging findings and treatment in coccydynia - update of the recent study findings.

BACKGROUND: Coccydynia is one of the most overlooked symptoms in clinical practice. The diagnosis and radiologic findings of traumatic coccyx can be more easily detected unless it is delayed and postponed. For idiopathic coccydynia, which accounts for one third of cases, patients present with long-standing pain and multiple physician visits. METHOD: The keywords coccyx, coccydynia, coccygodynia were searched in PubMed, Embase, Scopus databases in the last 5 years. Research articles, reviews and case reports were analyzed. The studies conducted in the last 5 years were presented under the headings of etiology, radiologic assessment, interventional and surgical treatments. RESULTS AND CONCLUSION: The first step is dynamic X-ray of the coccyx in standing and sitting position. In this way, morphologic parameters and hypermobility causing idiopathic coccydynia can be evaluated. Morphologic and morphometric features of the coccyx described in previous CT and MR studies have explained the relationship with coccydynia. The key features are as follows: Type II coccyx morphology, subluxation of the intercoccygeal joint, presence of bony spicules. Knowledge of these definitions as well as the differential diagnosis in this anatomical region will help in reaching the correct diagnosis. The treatment of coccydynia is stepwise like the diagnosis. Conservative treatments are initiated first. Manipulations, ganglion impar block, injections, radiofrequency and shock treatments and finally coccygectomy are treatment methods reported. Radiologists should not overlook this region and should be familiar with the coccyx's morphologic appearance and the sacrococcygeal region's differential diagnosis. KEY POINTS: · The etiology of coccydynia usually includes trauma, obesity and female sex, special coccyx morphology, and coccygeal hypermobility.. · Coccyx fractures are defined into three groups as flexion type 1, compression type 2, and extension type 3.. · When evaluating coccydynia, the first step is a dynamic X-ray examination of the coccyx in standing and sitting position.. · Hypermobility is defined as more than 25 % posterior subluxation while sitting or more than 25° flexion while sitting.. · More than 35° posterior subluxation is considered significant hypermobility..

The overlooked symptom of coccydynia: evaluation of sacrococcygeal morphologic and morphometric findings.

BACKGROUND: Coccydynia is one of the most overlooked symptoms in daily clinical practice. Definitions for radiologic evaluation are controversial. OBJECTIVES: We aimed to compare the morphology and morphometric measurements of the sacrococcygeal region with those of a healthy population to support radiologic decision-making. MATERIALS AND METHODS: In total, 26 traumatic and 50 idiopathic cases of coccydynia as well as 74 healthy control cases were retrospectively compared. The morphologic type of the coccyx, the presence of fusion, and the number of coccygeal segments were evaluated in both groups. Morphometric parameters such as sacrococcygeal angle (SCA), sacrococcygeal joint angle (SCJA), intercoccygeal angle (ICA), sacral slope (SS), coccyx curved length (CCL), sacrum curved length (SCL), coccyx length (CL), sacrum length (SL), and sacrococcygeal total length (SCTL) were investigated. RESULTS: Significant differences were found between the coccydynia group and the healthy control group in morphologic parameters such as female gender, coccyx segment, coccyx morphology, presence of sacrococcygeal joint, and segment of sacrococcygeal joint fusion (p < 0.05). In morphologic measurements, SCJA, SCL, SL, coccyx and sacrum curvature indexes were significantly increased (p < 0.05). No significant difference was found in the morphologic and morphometric parameters evaluated when compared with the duration of coccydynia (p > 0.05). CONCLUSION: An increase in the SCJA, SCL, SL, SCI, and coccyx curvature index measurements predisposes to coccydynia. It would be more accurate to perform radiological evaluation by familiarization with these morphologic and morphometric parameters.

Assessment of BNP and BDNF results in elective endovascular cerebral aneurysm treatment.

BACKGROUND: B-type natriuretic peptide (BNP) levels increase with an increase in intracranial pressure. A decrease in BNP levels has been found to be associated with patient positive prognosis. Brain-derived neurotrophic factor (BDNF) levels decrease in patients with acute stroke. AIMS: To compare the BNP and BDNF values in serum before and after elective endovascular cerebral aneurysm treatment (ECAT). METHODS: A total of 50 patients who underwent elective ECAT were included in the study. Exclusion criteria were determined to be history of heart failure or heart attack (n = 8), renal failure (n = 5), subarachnoid hemorrhage (n = 4), or previous aneurysm clip procedure (n = 3). Intravenous blood samples were obtained from 30 patients who underwent elective ECAT before and after treatment. After centrifugation, the BNP and BDNF values in serum were obtained with the ELISA method and compared. RESULTS: This study included 19 female and 11 male patients, aged between 24 and 75 years. The average age of the patients was 51.27 ± 13.31 years. The median BDNF values did not change significantly after ECAT (before the endovascular procedure: 3.1 ± 1.3 pg/dl; after the endovascular procedure: 2.8 ± 0.9 pg/dl, p = 0.16). Median BNP levels decreased significantly after ECAT (before the endovascular procedure: 617.50 ± 483.11 pg/ml; after the endovascular procedure: 395.00 ± 352.15 pg/ml, p < 0.001). CONCLUSIONS: After elective endovascular cerebral aneurysm treatment, the BNP values in serum decreased significantly, and the BDNF values in serum did not change significantly.

Mortality Outcomes of Endovascular Treatment and Surgical Clipping in Patients with Cerebral Aneurysms: A Single-Center Study.

AIM: To compare endovascular and surgical treatment methods for cerebral aneurysms focusing on mortality. MATERIAL AND METHODS: The study included 187 patients who had undergone aneurysm treatment. The patients were divided into four groups according to their treatment modality and subarachnoid hemorrhage status: patients with endovascular treatment and bleeding aneurysms (EVG-b), patients with endovascular treatment and non-bleeding aneurysms (EVG-nb), patients with surgical clipping and bleeding aneurysms (SCG-b), and patients with surgical clipping and non-bleeding aneurysms (SCG-nb). The Hunt?Hess scores, Fisher grade, aneurysm morphology, and length of stay (LOS) were compared between groups. RESULTS: There was no significant difference in the mortality rate between EVG-b and SCG-b at the end of the first year (23.5% and 39.7%, respectively; p > 0.05). A significantly shorter LOS was observed in EVG-b than in SCG-b (11.5 days and 15 days, respectively; p=0.027). Fusiform aneurysms were associated with higher patient mortality, whereas saccular aneurysms were associated with a 1.9-fold higher survival (p=0.037; 95% confidence interval: 0.83?4.74). The rate of closure of non-bleeding aneurysms was 93.4%. Complete embolization was verified in all bleeding aneurysms. In EVG-nb, the morbidity rate was 5%, the mortality rate was 3%, and the mean LOS was 2.86 days. CONCLUSION: Both treatment methods showed similar mortality rates, but hospital stays were shorter after endovascular treatment.