Brain structure and stroke risk score in subjects without a history of atrial fibrillation.

CHA2DS2-VASc score system aids in clinical decision-making in subjects with atrial fibrillation (AF). Little is known on the association between CHA2DS2-VASc scores and brain structure in patients without cardiac arrhythmia. Detailed brain architecture analysis was performed. Assessment of bivariate correlation between the volume of segmented brain structures and Z-scores of CHA2DS2-VASc showed that higher risk scores correlated negatively and significantly with various brain framework. Our study confirms that a cluster of risk factors incorporated in a well-established risk score correlated with brain tissue volume independently of the presence of an arrhythmia.

COVID-19 pandemic in flu season. Chest computed tomography - what we know so far.

Chest computed tomography (CT) is proven to have high sensitivity in COVID-19 diagnosis. It is available in most emergency wards, and in contrast to polymerase chain reaction (PCR) it can be obtained in several minutes. However, its imaging features change during the course of the disease and overlap with other viral pneumonias, including influenza pneumonia. In this brief analysis we review the recent literature about chest CT features, useful radiological scales, and COVID-19 differentiation with other viral infections.

Association of left atrial fibrosis with aortic excess pressure and white matter lesions.

Objectives. Left atrial fibrosis represents a substrate for atrial fibrillation (AF) and cardioembolic events. White matter hyperintensities (WMH) are commonly found on magnetic resonance imaging (MRI) and are regarded, at least partly as ischemic brain lesions. Aortic excess pressure (excessPTI) represents an extra work performed by the left ventricle and is a new risk metric associated with cardiovascular complications. The aim of our study was to assessed whether there is a correlation between the degree of LA fibrosis, aortic excess pressure, and WMH in patients without a history of atrial fibrillation but the presence of risk factors for cardiovascular complications. Design. Thirty-eight subjects (10, females, 28 males, median age 64 years) with risk factors (hypertension, diabetes, heart failure, vascular disease) but no history of AF were recruited. Left atrial fibrosis and brain WMH were estimated by MRI. Aortic excess pressure was obtained non-invasively. Results. Atrial fibrosis correlated significantly with aortic excess pressure (r = 0.65, p < .0001) and was significantly associated with periventricular white matter lesion volume (r = 0.34, p = .036). In multiple regression analysis, atrial fibrosis and age were positively associated with periventricular white matter lesions, while aortic excess pressure was not quite significant associated with WMH. This model explains the 30% variance in white matter lesions volume observed in the study. Left atrial fibrosis was independently associated with excessPTI but not with age and mean BP. This model explained 42% of the variance in an area of atrial fibrosis. Conclusions. Atrial fibrosis in subjects with cardiovascular risk factors and no history of AF is associated with white matter hyperintensities and aortic excess pressure.

Peripheral vascular malformations - modern imaging.

Currently the major aim in peripheral vascular malformation diagnosis, crucial for subsequent management and treatment, is to identify its haemodynamic characteristics. Other significant features that should be specified by a radiologist are the exact location of the anomaly, its size, and its morphology. Until recently the diagnostic methods available for comprehensive evaluation of malformations have been rather limited. Moreover, they were often associated with the necessity of exposing the patient to X-ray radiation and with invasive procedures, as for example in angiography. The development of imaging techniques used in the diagnosis of vascular abnormalities in recent years, especially magnetic resonance imaging, has contributed to improved diagnostic value of the tests. In this article we review the currently available imaging modalities with particular consideration of magnetic resonance imaging and its capability to distinguish between high- and low-flow malformations.

Standard therapy or additionally radioactive iodine (131I) therapy; which will stop the recurrence of glioblastoma multiforme (GBM)?

Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumour. The average survival time for a patient diagnosed with GBM, using standard treatment methods, is several months. Authors of the article pose a direct question: Is it possible to treat GBM solely with radioactive iodine (¹³¹I) therapy without employing the sodium iodide symporter (NIS) gene? After all, NIS has been detected not only in the thyroid but also in various tumours. The main author of this article (A.C.), with the assistance of her colleagues (physicians and pharmacologists), underwent ¹³¹I therapy after prior iodine inhibition, resulting in approximately 30% reduction in tumour size as revealed by magnetic resonance imaging (MRI). Classical therapy for GBM encompasses neurosurgery, conventional radiotherapy, and chemotherapy (e.g. temozolomide). Currently, tyrosine kinase inhibitors (imatinib, sunitinib, and sorafenib) are being used. Additionally, novel drugs such as crizotinib, entrectinib, or larotrectinib are being applied. Recently, personalised multimodal immunotherapy (IMI) based on anti-tumour vaccines derived from oncolytic viruses has been developed, concomitant with the advancement of cellular and molecular immunology. Thus, ¹³¹I therapy has been successfully employed for the first time in the case of GBM recurrence.

Renal morphology assessed by ultrasound in relation to central haemodynamics and body fat.

There is a correlation between renal function and the morphological characteristics of the kidney. However, little is known about the association between renal morphology and other important predictors of the risk of cardiovascular diseases, such as central haemodynamics or body fat. Thus, in the present study we investigated correlations between renal morphology, body fat and central haemodynamics. Renal morphology and intra-abdominal and subcutaneous fat were assessed by ultrasound, whereas central haemodynamics were evaluated by pulse wave analysis, in 93 healthy, non-obese subjects (mean (±SEM) age 52 ± 1 years; 43 men, 50 women). Significant correlations were found for indices of body fat (waist : hip ratio, body mass index and intra-abdominal fat) and renal morphology (kidney length, width and volume). Significant inverse correlations were found between central augmentation pressure (cAP) and kidney length (r = -0.33; P = 0.0009), width (r = -0.24; P = 0.01) and volume (r = -0.27; P = 0.007). In addition, significant negative correlations were found between the central augmentation index (cAIx) and kidney length (r = -0.36; P = 0.0003), width (r = -0.29; P = 0.003) and volume (r = -0.33; P = 0.0008). Multiple linear regression analysis revealed independent associations between kidney length and both cAP and cAIx. In conclusion, common morphometric characteristics of the kidney, as assessed by ultrasound, are associated with measures of body fat and descriptors of central haemodynamics. The relationships demonstrated in the present study indicate that these associations may be a biologically plausible phenomenon.

Arterial stiffness, body fat compartments, central hemodynamics, renal function and left atrial size.

BACKGROUND: Left atrial (LA) size is an important predictor of stroke, death, and atrial fibrillation. It was demonstrated recently that body fat, arterial stiffness and renal functions are associated with LA diameter. However, data are lacking for comprehensive assessments of all these risk factors in a single population. Therefore, the aim of the present study was to investigate the association between LA size and different fat descriptors, central hemodynamics, arterial stiffness, and renal function in healthy subjects. METHODS: To this end, body fat percentage, abdominal, subcutaneous fat, and general descriptors of body fat were estimated in 162 healthy subjects (mean age 51 years). Echocardiography was performed to assess LA diameter. Arterial stiffness and peripheral and central hemodynamics were estimated by digital volume pulse analysis and pulse wave analysis. Glomerular filtration rate was estimated by MDRD formula. RESULTS: There were significant (p < 0.05) bivariate correlations between LA diameter and all descriptors of body fat (except subcutaneous fat). Arterial stiffness and estimated glomerular filtration rate (eGFR) were also significantly correlated with LA size. Multiple regression analysis including all significant confounders, such as sex, mean arterial pressure, arterial stiffness, eGFR and body fat descriptors, explained 35% of variance in LA diameter. CONCLUSIONS: In conclusion, the present study reveals significant, independent relationships between body fat, arterial stiffness, and LA size.

The Usefulness of MRI Dynamic Flow Sequences in Differentiating High- and Low-Flow Vascular Malformations.

Peripheral arteriovenous malformations (PVMs) can be classified into high-flow malformations (HFVMs) and low-flow malformations (LFVMs). Adequate distinguishment is crucial for therapeutic decision and can be done using dynamic contrast-enhanced MRI (DCE-MRI). The main aim of this retrospective study was to determine the diagnostic value of quantitative DCE-MRI ratios for differentiation between HFVM and LFVM, their optimal cut-off points, and predictive values. DCE-MRI time-resolved angiography with stochastic trajectory (TWIST) examinations of 90 patients with PVMs were included [28 HFVM (31%), 62 LFVM (69%)]. The measurements of artery-lesion time, maximum lesion enhancement, slope of the enhancement curve, and maximum percentage increase of signal intensity (SI) were obtained. The optimal cut-offs for HFVMs calculated using the Youden index were: for slope of enhancement curve < 8.7 s (sensitivity of 86%, specificity of 89%), artery-lesion time ≤ 5.6 s (sensitivity of 89%, specificity of 77%), time to maximum enhancement ≤ 30 s (sensitivity of 94%, specificity of 100%), and maximum percentage enhancement of the lesion > 662% (sensitivity of 68%, specificity of 69%). To summarize, DCE-MRI is very valuable for differentiation between HFVM and LFVM, especially if quantitative measurements are done.

Assessment of the Results of Surgical Treatment of Zenker'S Diverticulum in Own Material.

UNLABELLED: Zenker diverticulum (ZD) is the most common type of diverticula of the esophagus. Most often refers to men with a peak incidence in the seventh and eighth decade of life. In the majority diverticula remains asymptomatic and in patients with symptomatic course of the disease symptoms are often nonspecific. Aim of the study was to present the authors' own experience in surgical treatment of Zenker diverticulum. MATERIAL AND METHODS: In this paper we present an analysis of 31 patients with confirmed ZD treated surgically at the Clinic in 2004-2014. Patients were analyzed in terms of age, gender, clinical symptoms, diverticulum size, type of surgery, the time to return to the oral intake, hospital stay and perioperative complications. RESULTS: 22 men and 9 women were enrolled it this study. The mean age of the patients was 64.8 (SD, 10.7; in the range of 28 to 82 years). 29 patients (93.5%) underwent resection of the diverticulum, while diverticulopexy was performed in two patients. In 25 (80.6%) cases stapler device was used, while in 4 (12.9%) resection was performed manually. The average size of resected diverticulum was 4.9 cm (SD, 1.5). Following the surgery in four patients (12.9%) complications were present. The average operating time was 118.7 minutes (SD, 42.2, in the range of 50 to 240 minutes). The mean length of hospital stay was 9.3 (SD, 3.3). CONCLUSIONS: Surgical treatment of ZD is associated with high effectiveness and low recurrence rate. Despite the advantages of endoscopic techniques, surgical treatment is characterized by one- stage procedure. The use of mechanical suture (stapler) significantly improves the operation, although on the basis of our own analysis there was no superiority revealed over hand sewn. Unquestionable adventage of classical technique is the opportunity to histopathological evaluation of resected diverticulum what is impossible to achieve in endoscopic techniques.

Transarterial thrombin injection secured with an embolic protection device as a treatment for a superior mesenteric artery pseudoaneurysm.

A pseudoaneurysm of the superior mesenteric artery (SMA) is a rare and life-threatening condition of various etiology. Even unruptured it can cause severe health problems or death. We report a 71-year-old male with a SMA pseudoaneurysm who was successfully treated with a transarterial thrombin injection secured with an embolic protection device used in carotid angioplasty. To our knowledge, this is the first case of a SMA pseudoaneurysm treated by this method.

Traumatic inferior gluteal artery aneurysm managed with emergency transcatheter thrombin injection.

Pseudoaneurysms of the inferior gluteal artery (IGA) are rare and are often caused by trauma. Treatment options vary and include surgery, ultrasound-guided percutaneous thrombin injection, and endovascular procedures such as stent-graft placement, coil embolization, and glue injection. We report a 70-year-old male who presented to the hospital after a road accident with a posttraumatic pseudoaneurysm that was treated by endovascular thrombin embolization. To the best of our knowledge, this is the first reported case of inferior gluteal artery false aneurysm treated by this method.