Increased Cardio-ankle Vascular Index Values in Migraine Patients With Aura.

Patients with migraine with aura are at an increased risk of cardiovascular disease. There are limited data on arterial stiffness in migraine patients with aura. The present study evaluated arterial stiffness in these patients using the cardio-ankle vascular index (CAVI). This prospective study included 50 patients with migraine with aura (43 female, mean age 38.9 ± 9.9 years). The patient group was matched for age and gender with 50 healthy individuals with no history of migraine (43 female, mean age 39.3 ± 10.3 years). All patients and control subjects underwent a comprehensive clinical evaluation by an experienced neurologist and were interviewed about their headache histories. There was no significant difference in baseline demographic characteristics and echocardiographic parameters between migraine with aura patients and the control group. Both right and left CAVI values were significantly higher in the patients with migraine with aura (6.5 ± 1.2 vs 6.1 ± 0.7, P = .043 and 6.6 ± 1.2 vs 6.1 ± 0.7, P = .009, respectively). Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI, a novel marker of the arterial stiffness, is increased in patients with migraine with aura.

Ongoing Effects of SARS-CoV-2 Infection on Arterial Stiffness in Healthy Adults.

There are limited data on the arterial stiffness changes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The present study evaluated the changes in arterial stiffness in completely healthy patients who had a SARS-CoV-2 infection using the cardio-ankle vascular index (CAVI). The study included 70 patients with SARS-CoV-2 infection between December 2020 and June 2021. A cardiac evaluation was carried out, including chest X-ray, electrocardiography (ECG), and echocardiography in all patients. Within the 1st month and 7th month CAVI was measured. Mean age was 37.8 ± 10.0 years, and 41/70 were female. Mean height was 168.6 ± 9.5 cm, mean weight 73.2 ± 15.1 kg, and mean body mass index (BMI) of the group was 25.6 ± 4.2, respectively. CAVI results from the right arm were 6.45 ± .95 at 1-month follow-up and 6.68 ± 1.05 at 7 months follow-up (P = .016) and from the left arm were 6.43 ± 1.0 at 1-month follow-up, 6.70 ± 1.05 at 7-month follow-up (P = .005). Our results showed an ongoing injury in the arterial system after healthy SARS-COV-2 patients during 7 months, as represented by CAVI measurements.

Flow Diversion Therapy of Remnant and Recurrent Intracranial Aneurysms Treated Surgically.

AIM: To evaluate the safety and efficacy of flow diverter stents (FDSs) for treating remnant or recurrent intracranial aneurysms that were treated surgically. MATERIAL AND METHODS: The patients who were treated with FDSs due to remnant or recurrent intracranial aneurysms after microsurgery were included in the study. The patients' demographics, treatment histories, aneurysm features, complications associated with flow diversion, and neurological and angiographic follow-up findings were evaluated. RESULTS: Twenty patients (eight males) with 20 aneurysms were included in the study. Of 20 aneurysms, 18 (90%) were in the anterior, and two (10%) were in the posterior circulation. The initial treatment methods were clipping in 17 (85%) and wrapping in three (15%) aneurysms. The endovascular procedure was successful in all patients. In three patients (15%), periprocedural and postprocedural complications were encountered. No hemorrhagic complications were detected on cone-beam computed tomography. One patient with a basilary aneurysm died because of brain stem ischemia. The total morbimortality was 5%. The mean length of follow-up was 13.7 ± 7.3 months in 18 patients. The first angiographic follow-up (3-6 months) revealed the complete occlusion in 7 of 11 aneurysms (63.6%). By contrast, 16 aneurysms (94.1%) were occluded at the last angiographic follow-up, one aneurysm (5.9%) was still filling. CONCLUSION: An FDS seems effective, safe, and extremely attractive in treating remnant and recurrent intracranial aneurysms treated surgically.

Surgical removal of atrial septal defect closure device due to systemic allergic reaction to nickel: A case report.

Systemic hypersensitivity reaction to nickel-containing medical device is a rare complication after percutaneous atrial septal defect closure. The symptoms regress spontaneously or in response to medical treatment in most cases. Surgical device removal is mandatory and effective in patients whose symptoms persist despite optimal medical therapy. Herein, we report a case of systemic allergic contact dermatitis secondary to nickel allergy after atrial septal defect closure and its successful treatment with surgical removal of the device.

The effects of intrauterine device on cervico-vaginal smears with liquid-based cytology technique: A North-Eastern Anatolia region study in Turkey.

Intrauterine device (IUD), is one of the most efficient methods of contraception. The aim of study to investigate the effects of intrauterine device in cervicovaginal smears with liquid based cytology technique in our patient population. Cervicovaginal smears of 5492 patients who sought the services of the pathology department in a sixmonth period were reviewed retrospectively. Samples were prepared with liquid based cytology technique. The patients using IUD as contraceptive method (n= 562 cases) were included in the study. The samples taken with the conventional method were excluded from the study. The results were categorized according to the Bethesda system. The age range of the patients was 18-61 years (mean age: 34.6). The most common diagnosis was "negative for intraepithelial lesion or malignancy" (97.2%). In 307 patients (54.6%) there were infection and only in 93 out of them (30.2%) a specific agent was detected. Actinomyces (11%) were recorded as the most common infectious agent, followed by Gardnerella vaginalis (2.8%) and Candida species (2.4%). There were reactive changes in 134 cases (23.8%). In 13 cases (2.3%) epithelial cell abnormalities were detected. The most common cytopathologic diagnosis was ASC-US (atypical squamous cells of undetermined significance) in patients who had epithelial cell abnormalities (2.1%). In conclusion, IUDs increase the frequency of genital infection by disrupting the genital flora. In our study the most frequent agent was Actinomyces, and this rate was higher than some studies. This high rate for Actinomyces may be associated with IUDs that are frequently used for contraception in Erzurum province with long term uses.

Demographic characteristics and neurological comorbidity of patients with COVID-19.

ABSTRACT: The COVID-19 infection that started in the Wuhan Province of the People's Republic of China and has now spread throughout the world is not limited to the respiratory system, but also causes other systemic symptoms through viremia. Recent data show that the central and peripheral nervous system involvement is particularly substantial. Thus, the present study aims to investigate the current neurological comorbidities and symptoms of patients with COVID-19 who were followed up by our clinic physicians.

Impact of antihypertensive agents on clinical course and in-hospital mortality: analysis of 169 hypertensive patients hospitalized for COVID-19.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. METHODS: Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. RESULTS: The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. CONCLUSION: The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.

Hematological biomarkers for predicting carotid artery vasospasm during carotid stenting.

INTRODUCTION: The vasospasm of carotid arteries is important for the progression of neurological sequelae. Many mechanisms have been found to be related to this clinical phenomenon. Predicting this event by using hematological biomarkers may provide opportunities for adopting preventive measures against unfavorable neurovascular complications. The aim of this study is to determine the hematological predictors of carotid artery vasospasm during carotid stenting. MATERIAL AND METHODS: A total of 120 patients who underwent carotid stenting were divided into two groups: those with and without carotid artery vasospasm. Carotid artery vasospasm was angiographically defined as transient or persistent emergent stenosis or irregularity of the vessel wall without evidence of thrombosis during carotid stenting. The hematological parameters were compared between 21 patients who developed carotid artery vasospasm (17.5%) and 99 patients who did not (82.5%). RESULTS: The mean age of the patients with carotid artery vasospasm and without carotid artery vasospasm was 66 ±8 and 70 ±8 years, respectively. Creatinine levels within 0.5-0.9 (OR = 3.704, 95% CI: 1.245-11.019, p = 0.019), each 1000 unit increase in neutrophil count (OR = 1.567, 95% CI: 1.027-2.392, p = 0.037) and presence of diabetes (OR = 3.081, 95% CI: 1.116-8.505, p = 0.030) were the independent predictors of carotid artery vasospasm in carotid arteries during carotid stenting. CONCLUSIONS: The prediction of carotid artery vasospasm during carotid stenting should help clinicians adopt preventive measures against the development of neurological sequelae. This study found that creatinine levels, increased neutrophil count and presence of diabetes are independent predictors of carotid artery vasospasm.

Complementary and alternative medicine experiences of mothers in the treatment of infantile colic.

Lack of effective medical treatment in infantile colic (IC) causes desperate mothers to apply for complementary and alternative medicine (CAM) treatments. Due to the possibility of benefits, the risks that may be incurred by these methods are often ignored by the parents. Therefore, information on the use of CAM methods in IC is needed. The aim of this study is to reveal the CAM experiences of mothers in IC treatment and the demographic characteristics that affect them. Mothers whose children were diagnosed as IC by a physician in the past were included in the study. The sociodemographic characteristics of the mothers, IC-diagnosed baby characteristics and CAM experiences were investigated face to face with a structured questionnaire. Sixty-six of 96 mothers who participated in the study used the CAM method. There was a statistically significant difference between the use of CAM and the education level of mothers (p < 0.05). We determined that 74% of mothers informed their doctors before starting treatments, and 82% do not believe if the CAM method could cause any harm that they would not notice by observing. The results showed that CAM methods are commonly used in IC treatment. According to these findings, mothers who use these methods believe that they are always harmless and have no side effects. For this reason, physicians should be careful about the adverse effects that may occur due to the CAM methods, which are widely used.

Increased cardio-ankle vascular index values in patients with acute branch retinal vein occlusion.

Purpose: Patients with retinal vein occlusions (RVOs) are at increased risk of cardiovascular disease. Arterial stiffness is an independent risk factor for cardiovascular events. Our aim is to evaluate the arterial stiffness in patients with acute branch retinal vein occlusion (BRVO) by using cardio-ankle vascular index (CAVI). Methods: This prospective study included 42 patients (18 male, mean age 57.5 ± 11.3) with acute BRVO and a matched control group (by age, sex, and presence of hypertension) with 70 (26 male, mean age 54.4 ± 9.4) patients. All patients and control subjects underwent complete ocular examination and CAVI measurement. BRVO was diagnosed based on clinical examination. Results: There were no significant differences between baseline clinical and demographic characteristics, echocardiographic measurements of left ventricular ejection fraction, systolic and diastolic blood pressure, and body mass index of the BRVO and control group. Both right and left CAVI values were found significantly higher in BRVO group (7.94 ± 1.53 vs 7.28 ± 1.25, P < 0.05 and 8.06 ± 1.41 vs 7.30 ± 1.26, P < 0.05, respectively). There were no significant difference in right and left ankle-brachial index values between the groups (1.05 ± 0.10 vs 1.06 ± 0.08, P = 0.46 and 1.04 ± 0.12 vs 1.05 ± 0.08, P = 0.46, respectively). Conclusion: Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI which is a novel marker of the arterial stiffness is increased in patients with acute BRVO compared to controls.

Does contralateral carotid artery occlusion affect the clinical and long-term outcomes of carotid artery stenting?

INTRODUCTION: Carotid artery stenting (CAS) has been used with increasing frequency in recent years as an alternative to surgery. Contralateral carotid occlusion (CCO) is present in approximately 2.3% to 25% of cases of revascularised carotid atherosclerotic stenosis. We aimed to compare the outcomes of 30-day, 6-month and 1-year stroke, transient ischaemic attack (TIA), death and myocardial infarction (MI) in patients with and without CCO who underwent CAS in our clinic. MATERIAL AND METHODS: The study was conducted with 288 consecutive patients who underwent CAS between September 2010 and June 2018. Patients with carotid stenting were divided into two groups: with (48 patients) and without CCO (240 patients). RESULTS: Total mortality (2.08% vs. 2.08% p = 1), stroke (2.08% vs. 0.83%, p = 0.43), TIA (0% vs. 0.83%, p = 0.52), MI (0% vs. 0%), and composite outcome (4.17% vs. 3.33%, p = 0.77) at 30 days were not significantly different between CCO and non-CCO groups. Also there was no statistically significant difference between the two groups in terms of the 6-month and 1-year outcomes (p > 0.05). CONCLUSIONS: There was no difference between 30-day, 6-month and 1-year non-fatal MI, TIA, ischaemic stroke and mortality in the comparison of patients with and without CCO who underwent CAS. The outcomes were similar in terms of age and symptoms, and these data should be supported by prospective multicenter studies.

Demographic characteristics and neurological comorbidity of patients with COVID-19

SUMMARY ABSTRACT The COVID-19 infection that started in the Wuhan Province of the People's Republic of China and has now spread throughout the world is not limited to the respiratory system, but also causes other systemic symptoms through viremia. Recent data show that the central and peripheral nervous system involvement is particularly substantial. Thus, the present study aims to investigate the current neurological comorbidities and symptoms of patients with COVID-19 who were followed up by our clinic physicians.

RESUMO RESUMO A infecção de COVID-19 que começou na província de Wuhan, na República Popular da China, e já se espalhou por todo o mundo não se limita ao sistema respiratório, mas também causa outros sintomas sistêmicos através de viremia. Dados recentes mostram que seus efeitos no sistema nervoso central e periférico são particularmente significativos. Assim, o presente estudo tem como objetivo investigar as atuais comorbidades e sintomas neurológicos de pacientes com COVID-19 que foram acompanhados pelos médicos da nossa clínica.

Impact of antihypertensive agents on clinical course and in-hospital mortality: analysis of 169 hypertensive patients hospitalized for COVID-19

SUMMARY OBJECTIVE Coronavirus disease 2019 (COVID-19) is an emerging health threat caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Previous studies have noted hypertension is associated with increased mortality due to COVID-19; however, it is not clear whether the increased risk is due to hypertension itself or antihypertensive agents. We aimed to evaluate the impact of antihypertensive agents on the clinical outcomes of hypertensive patients with COVID-19. METHODS Our study included 169 consecutive hypertensive patients hospitalized due to COVID-19 between March 20 and April 10, 2020. The demographic characteristics, clinical data, and type of antihypertensive agents being used were reviewed. RESULTS The mean age of patients was 65.8±11.7 years.30 patients(17.7%) died during hospitalization. A total of 142 patients(84%) were using angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), 91 (53.8%) were using diuretics, 69 (40.8%) were using calcium channel blockers (CCBs), 66 (39.1%) were using beta-blockers, 12 (7.1%) were using alpha-blockers, and 5 (2.9%) were using mineralocorticoid receptor antagonists (MRAs). There was no significant difference between survivors and non-survivors based on the type of antihypertensive agents being used. Binary logistic regression analysis showed that the type of the antihypertensive agent being used had no effect on mortality [OR=0.527 (0.130-2.138), p=0.370 for ACEIs/ARBs; OR=0.731 (0.296-1.808), p=0.498 for CCBs; OR=0.673 (0.254-1.782), p=0.425 for diuretics; OR=1.846 (0.688-4.950), p=0.223 for beta-blockers; OR=0.389 (0.089-1.695), p=0.208 for alpha-blockers; and OR=1.372 (0.107-17.639), p=0.808 for MRAs]. CONCLUSION The type of antihypertensive agent being used had no effect on the clinical course and mortality in hypertensive patients with COVID-19. The use of these agents should be maintained for the treatment of hypertension during hospitalization.

RESUMO OBJETIVO A doença de coronavírus 2019 (COVID-19) é uma ameaça emergente à saúde causada por um novo coronavírus denominado síndrome respiratória aguda grave coronavírus 2 (Sars-COV-2). Estudos anteriores observaram que a hipertensão está associada a um aumento da mortalidade devido ao COVID-19, no entanto, não está claro se o aumento do risco pertence à própria hipertensão ou a agentes anti-hipertensivos. Nosso objetivo foi avaliar o impacto de agentes anti-hipertensivos nos resultados clínicos em pacientes hipertensos com COVID-19. MÉTODOS Nosso estudo incluiu 169 hipertensos consecutivos internados por COVID-19 entre 20 de março e 10 de abril de 2020. As características demográficas, dados clínicos e o tipo de anti-hipertensivos em uso foram revistos. RESULTADOS A idade média dos pacientes foi de 65,8±11,7 anos. Trinta pacientes (17,7%) faleceram durante a internação. Cento e quarenta e dois pacientes (84%) usavam inibidores da enzima de conversão da angiotensina (ACEIs) ou bloqueadores dos receptores da angiotensina II (ARBs), 91 (53,8%) usavam diuréticos, 69 (40,8%) usavam bloqueadores dos canais de cálcio (CCBs), 66 (39,1%) usavam betabloqueadores, 12 (7,1%) usavam bloqueadores alpha e cinco (2,9%) usavam antagonistas dos receptores de mineralocorticoides (MRAs). Não houve diferença significativa entre sobreviventes e não sobreviventes com base no tipo de agentes anti-hipertensivos em uso. A análise de regressão logística binária mostrou que o tipo de agente anti-hipertensivo utilizado não teve efeito na mortalidade (OR=0,527 (0,130-2,138), p=0,370 para ACEIs/ARB; OR=0,731 (0,296-1,808), p=0,498 para CCBs; OR=0,673 (0,254-1,782), p=0,425 para diuréticos; OR=1,846 (0,688-4,950), p=0,223 para bloqueadores beta; OR=0,389 (0,089-1,695), p=0,208 para bloqueadores alpha e OR=1,372 (0,107-17,639), p=0,808 para MRAs). CONCLUSÃO O tipo de agente anti-hipertensivo utilizado não teve efeito no curso clínico e na mortalidade em pacientes hipertensos com COVID-19. O uso desses agentes deve ser mantido no tratamento da hipertensão durante a hospitalização.

Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality.

INTRODUCTION: This study aims to evaluate the effect of primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) on the in-hospital adverse events, in-hospital and long-term mortality in patients over 65 years of age with acute ST-segment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: A total of 111 retrospectively screened patients (73 males, mean age: 73.4 ±5.9 years) over 65 years of age with STEMI, who underwent TT or primary PCI, were included in the study. Patients' characteristics, in-hospital outcomes, and 6-month and 1-year mortalities were recorded. RESULTS: Our study was conducted with 111 patients over 65 years of age with STEMI (73 males, 38 females). Of the patients, 66 (59.5%) were treated with thrombolytics, and 45 (40.5%) patients underwent primary PCI. Door-to-needle time was 25.9 ±7.8 min in the TT group, whereas door-to-balloon time was 84.4 ±20.0 min in the PCI group. Time from symptom onset to hospital admission was 213.6 ±158.4 min in the thrombolytic group, and 166.8 ±112.8 min in the PCI group. Rescue PCI was performed in 7 (10.6%) patients in the TT group due to lack of reperfusion. Recurrent infarction was observed in 5 (7.6%) patients in the TT group and in 2 (4.4%) patients in the PCI group. Non-haemorrhagic stroke was observed in 1 (1.5%) patient in the thrombolytic-administered group and in 4 (8.9%) patients in the PCI group. No intracranial haemorrhage was observed in any patient. Major haemorrhage was observed in 4 (6.1%) patients in the TT group and in 4 (8.9%) patients in the PCI group. Six-month and 1-year mortalities were present in 15 (22.7%) patients and 19 patients in thrombolytic group, and 8 (17.8%) and 8 (17.8%) patients in the PCI group, respectively. Binary logistic regression analysis indicated that the patient's age was the only predictor for 1-year mortality (odds ratio (OR) = 1.1, 95% confidence interval (CI): 1.019-1.188, p = 0.015). CONCLUSIONS: Considering the in-hospital adverse outcomes, in-hospital mortality, and 6-month mortality rates, TT and primary PCI have similar effects in STEMI patients aged 65 years and over according to the results of our study. Although 1-year mortality was higher in the TT group, it was not statistically significant.

Rare Location for Pilonidal Sinus: the Nasal Dorsum.

Pilonidal sinuses are recurrent chronic inflammatory lesions which may occur due to penetration of hair particles into skin. Herein, the authors report a pilonidal sinus case that is unusually seen on nasal dorsum and totally excised with the open technique rhinoplasty method. A 20-year-old male patient was admitted to the authors' outpatient clinic with complaints of dysmorphism and discharge from nasal dorsum. Physical examination revealed a swelling in nasal dorsum and hair-containing fistula. Excision was performed with an open rhinoplasty approach. Histo-pathology examination revealed pilonidal sinus. While pilonidal sinus is usually located in sacro-coccygeal region, it may also be seen in atypical localizations like nasal dorsum. Although the prediagnosis of a hair-containing lesion usually includes dermoid cyst, pilonidal sinus should also be considered and histo-pathological examination should certainly be performed. It is a problematic condition when it is symptomatic; however, management and treatment of the disease is easy when correct diagnosis is made.

Predictors of periprocedural complications of carotid artery stenting - a multivariate analysis of a single-centre experience.

BACKGROUND: Carotid artery stenting (CAS) is currently used as an alternative treatment to carotid endarterectomy (CEA). The objective of this study was to analyse our 5-year experience performing CAS. Secondarily, we sought to determine independent risk factors which predict periprocedural complications. PATIENTS AND METHODS: A total of 146 patients who underwent 153 CAS procedures were analysed. The majority of patients (123, 84.2%) had symptomatic carotid stenosis. Demographic and interventional data, angiographic lesion characteristics, and periprocedural complications were recorded. Using univariate and multivariate logistic regression analyses, risk factors associated with adverse clinical outcomes were determined. RESULTS: Periprocedural neurological complications, including four (2.7 %) major strokes, three (2 %) transient ischaemic attacks, one (0.7%) amaurosis fugax, and two (1.3 %) cases of hyperperfusion syndrome occurred in ten (6.8%) patients. The incidence of periprocedural complications significantly increased in female patients (r = 0.214, p = 0.009) and patients with longer lesions (r = 0.183, p = 0.027), contralateral stenosis ≥50 % (r = 0.222, p = 0.007), the presence of complicated plaques (r = 0.478, p < 0.001) and inadequate glycaemic control (r = 0.259, p = 0.002). Multivariate regression analysis also determined four variables to be potential independent risk factors for 30-day adverse events: higher age (Odds ratio [OR] = 1.283; 95 % CI, 1.051 to 1.566, p = 0.014); longer lesions (OR = 1.459, 95 % CI, 1.124 to 1.893, p = 0.004); higher tortuosity index (OR = 1.015, 95 % CI, 1.001 to 1.030, p = 0.034), and the presence of complicated plaque morphology (OR = 4.321, 95 % CI, 1.621 to 10.23, p = 0.001). CONCLUSIONS: Patient and lesion characteristics including age, lesion length, complicated plaque morphology and tortuosity index, may be associated with periprocedural complications.

Spontaneous left main coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a very rare clinical condition. Physiopathology of SCAD is still mostly unclear. Clinical presentation of SCAD ranges from atypical symptoms to sudden cardiac death. The diagnosis of dissection is generally made by using conventional coronary angiography. Invasive or conservative treatment is reasonable.

An investigation of pulse transit time as a blood pressure measurement method in patients undergoing carotid artery stenting.

INTRODUCTION: Pulse transit time (PTT) is the duration that a pulse wave takes to travel between two different arterial points, and it may be useful in estimating blood pressure. The aim of this study was to investigate the PTT during carotid artery stenting, as well as its value in blood pressure estimation. METHOD: Thirty-four patients with critical carotid artery stenosis were enrolled in this study. The carotid PTT from the onset of the R-wave of electrocardiography to the pulse waveform at the carotid artery, obtained invasively during carotid artery catheterization, was measured. The carotid PTT was measured before and after stenting of the internal carotid artery. RESULTS: The mean age was 70.4±8.0 years among the 34 patients enrolled (eight female patients, 21.9%). Measurements were obtained before and after carotid artery stenting. The heart rate (85.9±15.9 vs. 76.9±12.5 bpm, P<0.01), systolic blood pressure (162.8±28.6 vs. 126.0±31.7 mmHg, P<0.001), diastolic blood pressure (87.7±17.9 vs. 76.9±20.0 mmHg, P<0.01), and mean blood pressure (112.7±18.6 vs. 93.2±22.7 mmHg, P<0.001) were significantly decreased, whereas the carotid PTT (0.06±0.012 s vs. 0.07±0.012 s, P<0.001) was significantly increased after carotid stenting. The difference between the PTTs was negatively correlated with the systolic blood pressure (r=-0.35, P=0.02) and diastolic blood pressure (r=-0.4, P=0.01). CONCLUSION: After carotid stenting, the PTT increases significantly because of the lowering of the blood pressure. However, the relationship is not strong enough for the PTT to be used for blood pressure estimation.

Schwannoma Originating From the Nasal Septum.

Schwannomas are benign tumors deriving from Schwann cells of the nerve sheath. They can occur in all parts of the body. Involvement of the nasal septum is quite rare, with only few cases having been reported in the literature. The authors present a patient with a unilateral tumor diagnosed as a schwannoma of the nasal septum.