Association between Left Atrial Appendage Morphology and Clot Histology in Patients with Embolic Ischemic Stroke: An Exploratory Study.

BACKGROUND: Acute embolic ischemic stroke poses a significant healthcare challenge. Histological clot features' variability among patients with acute ischemic stroke treated by mechanical thrombectomy has potential implications for determining treatment and etiology. This study investigated the clot histological feature differences among patients who experienced cardioembolic stroke and embolic stroke of undetermined source with different left atrial appendage (LAA) morphologies. METHODS: We conducted a prospective observational study involving 79 patients with acute embolic ischemic stroke undergoing mechanical thrombectomy. Computed tomography angiography images were used to classify LAA morphologies. An artificial intelligence algorithm assessed the clot fibrin and red blood cell contents. RESULTS: Patients with chicken-wing LAA morphology exhibited lower mean clot fibrin proportions than did those with non-chicken-wing morphology (p < 0.001). Linear regression analysis showed that chicken-wing LAA was significantly associated with a lower clot fibrin proportion (estimate, -0.177; 95% CI [-0.259, -0.096]; p < 0.001). The successful recanalization rate and first-pass effect between the groups did not differ significantly. CONCLUSIONS: The chicken-wing LAA morphological type is associated with lower clot fibrin contents, suggesting potentially different embolism mechanisms or diverse embolic sources, compared with the non-chicken-wing LAA types. Further studies are required to investigate this association.

Assessing Liver Fibrosis Using 2D-SWE Liver Ultrasound Elastography and Dynamic Liver Scintigraphy with 99mTc-mebrofenin: A Comparative Prospective Single-Center Study.

Background and Objectives: Many quantitative imaging modalities are available that quantify chronic liver disease, although only a few of them are included in clinical guidelines. Many more imaging options are still competing to find their place in the area of diagnosing chronic liver disease. We report our first prospective single-center study evaluating different imaging modalities that stratify viral hepatitis-associated liver fibrosis in a treatment-naïve patient group. Materials and Methods: The aim of our study is to compare and to combine already employed 2D shear wave elastography (2D-SWE) with dynamic liver scintigraphy with 99mTc-mebrofenin in chronic viral hepatitis patients for the staging of liver fibrosis. Results: Seventy-two patients were enrolled in the study. We found that both 2D-SWE ultrasound imaging, with dynamic liver scintigraphy with 99mTc-mebrofenin are able to stratify CLD patients into different liver fibrosis categories based on histological examination findings. We did not find any statistically significant difference between these imaging options, which means that dynamic liver scintigraphy with 99mTc-mebrofenin is not an inferior imaging technique. A combination of these imaging modalities showed increased accuracy in the non-invasive staging of liver cirrhosis. Conclusions: Our study presents that 2D-SWE and dynamic liver scintigraphy with 99mTc-mebrofenin could be used for staging liver fibrosis, both in singular application and in a combined way, adding a potential supplementary value that represents different aspects of liver fibrosis in CLD.

Quantitative Assessment of Liver Impairment in Chronic Viral Hepatitis with [99mTc]Tc-Mebrofenin: A Noninvasive Attempt to Stage Viral Hepatitis-Associated Liver Fibrosis.

Background and objectives-Chronic viral hepatitis B and C infections are one of the leading causes of chronic liver impairment, resulting in liver fibrosis and liver cirrhosis. An early diagnosis with accurate liver fibrosis staging leads to a proper diagnosis, thus tailoring correct treatment. Both invasive and noninvasive techniques are used in the diagnosis and staging of chronic liver impairment. Those techniques include liver biopsy, multiple serological markers (as either single tests or combined panels), and imaging examinations, such as ultrasound or magnetic resonance elastography. Nuclear medicine probes may also be employed in staging liver fibrosis, although the literature scarcely reports this. The purpose of our study was to investigate whether a dynamic liver scintigraphy with [99mTc]Tc-mebrofenin has any value in staging or grading chronic liver damage. Materials and Methods-We prospectively enrolled patients with chronic viral hepatitis B and C infection referred for liver biopsy. All patient underwent dynamic liver scintigraphy with 99mTc-mebrofenin prior to liver biopsy. Dynamic liver scintigraphy was performed immediately after intravenous tracer injection for 30 min scanning time. Multiple scintigraphy parameters were calculated (whole liver lobe and focal area time to peak (TTP), 30 min to peak ratio (30/peak), whole lobe and focal area slope index in 350 s (slope_350). Liver biopsy took place shortly after imaging. Results-We found that many dynamic scintigraphic parameters are positively or negatively associated with different stages of liver fibrosis. The main parameters that showed most value are the ratio between 30 min and the peak of the dynamic curve (30/peak_dex (ratio)), and liver clearance corrected for body surface area and liver area (LCL_m2_dm2 (%/min/m2/dm2)). Conclusions-Our present study proves that conducting dynamic liver scintigraphies with [99mTc]Tc-mebrofenin has potential value in staging liver fibrosis. The benefits of this method, including whole liver imaging and direct imaging of the liver function, provide an advantage over presently used quantitative imaging modalities.

Transcatheter arterial embolization for upper gastrointestinal tract bleeding.

INTRODUCTION: Transcatheter arterial embolization is a possible treatment for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic management and is also an alternative to surgical treatment. AIM: To analyze the outcomes of transcatheter arterial embolization and identify the clinical and technical factors that influenced the rates of morbidity and mortality. MATERIAL AND METHODS: A retrospective analysis was carried out, based on the data of 36 patients who underwent transcatheter arterial embolization for acute nonvariceal upper gastrointestinal bleeding in 2013 to 2015 in our center. An analysis was performed between early rebleeding rates, mortality and the following factors: patient sex, age, number of units of packed red blood cells and packed plasma administered to the patients, length of hospital stay, therapeutic or prophylactic embolization. RESULTS: The technical success rate of the embolization procedure was 100%. There were 15 (41.70%) therapeutic embolizations and 21 (58.3%) prophylactic embolizations. There was a 77.8% clinical success rate. Following embolization, 10 (27.80%) patients had repeated bleeding and 9 (25.0%) patients died. Significant associations were found between rebleeding and prophylactic embolization (OR = 10.53; p = 0.04) and between mortality and prophylactic embolization (OR = 10.53; p = 0.04) and units of packed red blood cells (OR = 1.25; p < 0.01). CONCLUSIONS: In our experience, transcatheter arterial embolization is a safe treatment method for acute nonvariceal upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.

Transanal endoscopic microsurgery for rectal adenomas: single center experience.

INTRODUCTION: Transanal endoscopic microsurgery (TEM) is a method of choice for the local treatment of rectal adenomas. Though generally considered as a safe method, some authors have expressed skepticism about the anorectal function following TEM. AIM: To review our experience in using TEM for removal of rectal adenomas. We focused on morbidity, local recurrence rates, and anorectal function following the operation. MATERIAL AND METHODS: The study included 72 patients who underwent TEM for rectal adenomas from December 2009 to November 2014 at the Department of Surgical Oncology, National Cancer Institute. Of the 72 patients, 31 (43.1%) were lost in the follow-up. We recorded the demographics, operative details, final pathology, post-operative length of stay, post-operative complications, recurrences and functional outcome for each of the 41 (56.9%) remaining participants. RESULTS: Of the 41 eligible patients, 19 (46.3%) were male and 22 (53.7%) were female. The mean age of our patients was 66.8 years. There were no intraoperative complications. In 4 (9.8%) cases, postoperative complications were observed - urinary retention (2 cases, 4.9%) and postoperative hemorrhage (2 cases, 4.9%). All complications were treated conservatively. There was a single case (2.4%) of adenoma recurrence during the follow-up period. The mean score of the FISI questionnaire was 7.6 ±9.2 (ranging from 0 to 36), and the mean Wexner score was 2.3 ±3.4 (ranging from 0 to 17). CONCLUSIONS: Transanal endoscopic microsurgery in our experience demonstrated low complication and recurrence rates, and good functional results. We conclude that TEM is an effective and safe method for the treatment of rectal adenomas.