Forty-five degree wrist angulation is optimal for ultrasound guided long axis radial artery cannulation in patients over 60 years old: a randomized study.

Arterial cannulation is a common anaesthetic procedure that might be challenging and time-consuming in elderly patients. To establish an appropriate wrist joint position for arterial cannulation is crucial for ultrasound (US)-guided cannulation success. This study aimed to find out the optimal wrist joint angle for long axis in-plane (LA-IP) US-guided approach in radial artery cannulation in elderly patients. One hundred patients over 60 years old, who were assumed to require an arterial catheter for continuous blood pressure monitoring or frequent blood gas analysis in the intensive care unit or in the operating room were included in this prospective randomized study. Patients were randomized to five groups according to the wrist positions (0°, 15°, 30° 45° and 60° groups) for LA-IP approach for radial artery cannulation. Cannulation time (s), number of attempts, total success rate (%), first attempt success rate were recorded in all patients. Mean radial artery height was increased in 45° group compared to other groups (p < 0.05). Distance between skin and radial artery in 45° and 60° groups were statistically significantly decreased compared to 0° group (p < 0.05 for all comparisons). Mean cannulation time of 45° group was statistically decreased compared to other groups (p < 0.05). Number of attempts and total success rate were similar among groups, whereas first attempt success rate was significantly increased in 45° group compared to other groups (p < 0.05). Mean arterial height of the first attempt successful group was statistically increased compared to the first attempt failed group (p < 0.001) and mean cannulation time and mean number of attempts were also negatively correlated with arterial height (p < 0.001; for all comparisons). The 45° wrist angle increment might be advantageous in US-guided LA-IP radial artery cannulation in elderly patients in view of cannulation time and first attempt success rate.

Joubert syndrome: the clinical and radiological findings.

Joubert syndrome is a rare disease characterised by clinical and radiological findings. Among the classic clinical findings of JS are hypotonia, ataxia, mental-motor retardation, respiratory and opthalmological findings. The paediatric cases included in the study comprised nine patients. There was familial consanguinty in seven cases. Clinically, all cases had mental-motor retardation and hypotonia. Episodic hyperpnoea attacks were observed in one case. Facial dysmorphism was the most common additional systemic anomaly and four cases had additional opthalmic findings. Brain MRI examination revealed that all cases had molar tooth sign, bat-wing appearance and vermian cleft. The majority of cases also had vermian hypoplasia. Cerebellar folial disorganisation was observed in approxiamtely half of the cases. Three cases had corpus callosum anomaly and atretic occipital encephalocoele. No pathology was determined in other organs. This study aimed to evaluate the clinical and radiological findings of 9 patients diagnosed with Joubert syndrome.

Association of parity with osteoprotegerin levels and atherosclerosis.

PURPOSE: Association of serum osteoprotegerin (OPG) levels and cardiovascular disorders has been shown previously. The aim of this observational study was to investigate the relationship between parity, OPG and carotid intima-media thickness (CIMT) in premenopausal women. METHODS: A total of 128 women (mean age ± SD, 37.8 ± 4.7 years) were divided into three group according to parity [1-3 as group 1 (n = 41), 4-6 as group 2 (n = 55) and ≥7 as group 3 (n = 32)]. Serum OPG was measured and CIMT was evaluated. RESULTS: Both serum OPG levels and CIMT tended to increase with advancing parity; OPG level was significantly higher in group 3 than in group 1 (p = 0.013) and CIMT was significantly higher in group 2 and group 3 than in group 1 (p < 0.001 for both). In correlation analyses, there were significant correlations between all three parameters. CONCLUSIONS: Our results revealed that there was an increased risk of cardiovascular disease in women with multiparity. Significant association of OPG with CIMT suggested that OPG might play a role in the pathogenesis of parity-induced atherosclerosis.

Diffusion Weighted Imaging in Spine Tumors.

Diffusion weighted imaging (DWI) has developed into a powerful tool for the evaluation of spine tumors, particularly for the assessment of vertebral marrow lesions and intramedullary tumors. Advances in magnetic resonance techniques have improved the quality of spine DWI and diffusion tensor imaging (DTI) in recent years, with increased reproducibility and utilization. DTI, with quantitative parameters such as fractional anisotropy and qualitative visual assessment of nerve fiber tracts, can play a valuable role in the evaluation and surgical planning of spinal cord tumors. These widely available techniques can be used to enhance the diagnostic evaluation of spinal tumors.

Preoperative cerebral angiography nearly doubles the rate of diffusion-weighted imaging lesion detection following minimally invasive surgery for intracerebral hemorrhage.

BACKGROUND: Diffusion-weighted imaging (DWI) lesions have been linked to poor outcomes after intracerebral hemorrhage (ICH). We aimed to assess the impact of cerebral digital subtraction angiography (DSA) on the presence of DWI lesions in patients who underwent minimally invasive surgery (MIS) for ICH. METHODS: Retrospective chart review was performed on ICH patients treated with MIS in a single health system from 2015 to 2021. One hundred and seventy consecutive patients who underwent postoperative MRIs were reviewed. Univariate analyses were conducted to determine associations. Variables with p<0.05 were included in multivariate analyses. RESULTS: DWI lesions were present in 88 (52%) patients who underwent MIS for ICH. Of the 83 patients who underwent preoperative DSA, 56 (67%) patients demonstrated DWI lesions. In this DSA cohort, older age, severe leukoaraiosis, larger preoperative hematoma volume, and increased presenting National Institutes of Health Stroke Score (NIHSS) were independently associated with DWI lesion identification (p<0.05). In contrast, of 87 patients who did not undergo DSA, 32 (37%) patients demonstrated DWI lesions on MRI. In the non-DSA cohort, presenting systolic blood pressure, intraventricular hemorrhage, and NIHSS were independently associated with DWI lesions (p<0.05). Higher DWI lesion burden was independently associated with poor modified Rankin Scale (mRS) at 6 months on a univariate (p=0.02) and multivariate level (p=0.02). CONCLUSIONS: In this cohort of ICH patients who underwent minimally invasive evacuation, preprocedural angiography was associated with the presence of DWI lesions on post-ICH evacuation MRI. Furthermore, the burden of DWI lesions portends a worse prognosis after ICH.

Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes.

The aim of our study was to evaluate serum amyloid A (SAA), an acute phase reactant, and carotid intima-media thickness (CIMT) as a valid predictor of atherosclerosis in women with gestational diabetes mellitus (GDM). Serum samples from 39 pregnant women with GDM and 25 healthy pregnant women were collected for the analysis of SAA. CIMT was measured in both groups to evaluate future atherosclerotic heart disease risk. The SAA level was measured with ELISA. The mean arterial blood pressure (MABP), CIMT and SAA levels were significantly higher in women with GDM compared with healthy pregnant controls (p = 0.033, p = 0.001 and p = 0.004, respectively). There were significant correlations between SAA and age, BMI, MABP, 50-g oral glucose tolerance test (OGTT), and A1c (p = 0.048, p = 0.037, p = 0.035, p = 0.042 and p = 0.048, respectively) and between CIMT and BMI, MABP, and 50-g OGTT, (p = 0.001, p = 0.004 and p < 0.001, respectively) in correlation analysis. Furthermore, there was a correlation between SAA and CIMT (p = 0.048). Increased SAA and CIMT values in GDM compared with healthy controls might indicate an increased risk of subclinical atherosclerosis and future atherosclerotic heart disease and the importance of inflammation in this process. These changes were associated with obesity, hypertension and glucose intolerance-related factors (BMI, MABP, and 50-g OGTT), which may be relevant to GDM pathophysiology.

Evaluation of carotid intima-media thickness, a marker of subclinical atherosclerosis, in children with cerebral palsy.

BACKGROUND: Respiratory and cardiovascular diseases are the most common causes of death in children with cerebral palsy. OBJECTIVE: To evaluate sonographic carotid intima-media thickness, an early marker of atherosclerosis, in children with cerebral palsy and in healthy controls. MATERIALS AND METHODS: One hundred children with cerebral palsy (65 boys), mean age 6.2 (SD, 2.1) years, and 35 age-matched and sex-matched healthy controls were included. Common carotid artery intima-media thickness was measured sonographically. Differences between patients and controls were evaluated with an independent samples t-test. RESULTS: Age, sex distribution and levels of serum lipids were comparable between patients and controls. Average, right and left carotid artery intima-media were thicker in patients compared with controls (mean ± SD, 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.14 mm vs 0.40 ± 0.03 mm; 0.61 ± 0.13 mm vs 0.40 ± 0.03 mm, respectively; all P < 0.001). CONCLUSION: Carotid intima-media is sonographically thicker in children with cerebral palsy compared with healthy controls, which may express an increased risk of atherosclerotic diseases.

Infected primary paraspinal hydatidosis with water lily sign.

BACKGROUND: Primary muscular hydatidosis is extremely rare, and the diagnosis of the infected muscular hydatid cyst can be difficult due to atypical clinical and radiological findings. CASE REPORT: We present herein an interesting case of a 24-year-old man with primary infected muscular hydatid cyst located in the paraspinal muscles eroding the right lamina of C6 vertebra that was diagnosed with water lily sign on computed tomography. CONCLUSION: Water lily sign is a pathognomonic imaging finding for hydatidosis, and defined when free-floating endocyst is seen. Cyst hydatid should always be considered in the differential diagnosis of any soft tissue mass of the patients from endemic regions.

A rare case of petrous apex osteoma.

Osteomas are the most common tumours of the cranial vault and facial skeleton. Temporal bone osteoma is a rare entity. An osteoma arising from the petrous apex is extremely rare. We present a case of osteoma arising from the petrous apex followed by a discussion of the etiology, presentation, and radiologic findings.

Concurrence of the tortuosity of bilateral common and left internal carotid arteries in a case with common origin of the innominate trunk and left common carotid artery.

Anatomical variations of carotid arterial system, which are not infrequently encountered, have great impact on the surgical approaches of the neck. Although few reports on common carotid artery tortuosity have been published, no case of symptomatic concurrent common carotid and internal carotid artery tortuosity has been reported. Herein, we report the first case with concurrent common origin of the innominate trunk and left common carotid artery and common and internal carotid artery tortuosity presenting with an oropharyngeal mass.

Association of breast arterial calcification and carotid intima-media thickness.

Breast arterial calcification (BAC) on mammography has been identified as calcific medial sclerosis of medium-sized breast arteries, and has been reported to be associated with cardiovascular risk factors, coronary artery disease, and cardiovascular mortality. Carotid intima-media thickness (C-IMT) is a well-known surrogate marker of atherosclerosis and predictor of cardiovascular morbidity and mortality. Consequently, the present study was designed to investigate the association between the presence of BAC on mammography and C-IMT. Twenty-five postmenopausal cases with BAC and 29 subjects without BAC on mammography were included in the study. Cardiovascular risk factors, number of childbirths, postmenopausal duration, and age at menopause were all noted besides detailed physical and laboratory examination. In the whole study population C-IMT was measured with B-mode ultrasound. The women with BAC had significantly increased number of childbirths, postmenopausal duration, frequency of diabetes mellitus, systolic blood pressure, fasting glucose, and CIMT (0.87 +/- 0.17 mm versus 0.60 +/- 0.19 mm) in comparison with the women without BAC (P < 0.05 for all). The C-IMT was correlated with age, number of childbirths, postmenopausal duration, presence of BAC, and serum triglyceride level (P < 0.05 for all). Independent predictors of C-IMT were the presence of BAC on mammography (beta = 0.463, P < 0.001) and serum triglyceride level (beta = 0.222, P = 0.042), whereas the only independent predictor of BAC was CIMT (chi(2) = 23.41, beta = 7.56, P = 0.004). Findings of the present study suggest that the BAC on mammography is independently associated with C-IMT. Screening mammographies merit to be evaluated for the presence of BAC, which might benefit cardiovascular preventive medicine in women by predicting atherosclerosis.

Assessment of lower extremity arterial blood flow in females with knee osteoarthritis.

To investigate whether blood flow in the lower extremity arteries changes in patients with osteoarthritis (OA) using color Doppler ultrasonography. The study comprised 39 female patients with osteoarthritis and 30 healthy female controls. The patients were evaluated using visual analogue scale (VAS) at rest and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Color Doppler imaging was used to measure mid-diastolic velocity (MD), pulsatility index (PI), peak systolic velocity (PS), end-diastolic velocity (ED), vascular diameter, and flow volume in the external iliac (EIA), common femoral (CFA), superficial femoral (SFA), deep femoral (DFA), popliteal (PA), anterior tibial (ATA), posterior tibial (PTA), and distal superficial femoral arteries (DSFA). The femoral artery intima-media thickness (FIMT) was also measured. OA patients' PS and flow volume in the EIA and SFA were greater than those of controls, as were PI and ED in the EIA, ED in the PA, MD in the DFA, and the diameter of the PA, ATA, and PTA (p < 0.05). There were no statistically significant differences in FIMT between patients with knee OA and controls (p > 0.05). The flow volume of the main arteries feeding the knee joint is significantly greater than normal in patients with symptomatic knee OA. No evidence was identified relating this difference to ischemic processes.