Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular mortality.

INTRODUCTION: Long-term variability in systolic blood pressure (SBP) is associated with a higher risk of cardiovascular events. Little is known about any association between within-visit SBP variability, stroke, coronary heart disease (CHD), and cardiovascular (CV) death. MATERIAL AND METHODS: Participants included adults ≥ 18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2012 linked to the national death index in 2012. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according to standard procedures. Within-visit SBP variability was defined as the standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and the odds of stroke or CHD using multivariable logistic regression, and with CV mortality, using multivariable Cox regression. RESULTS: Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were white, and 10.7% were black. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all p < 0.05). The prevalence of stroke significantly increased across SBP variability quartiles, from 2.1% for quartile 1 to 3.7% for quartile 4 (p < 0.001). High SBP variability was associated with higher odds of stroke [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2], coronary heart disease (OR 2.0, 95% CI 1.6-2.4), and increased risk of CV mortality [hazard ratio (HR) 2.7, 95% CI 2.3-3.1]. The relationships were not observed after adjusting for covariables. CONCLUSIONS: Within-visit variability in SBP is associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality, but the relationship is confounded by age and covariates.

Greater burden of white matter lesions and silent infarcts ipsilateral to carotid stenosis.

OBJECTIVES: Carotid stenosis may cause silent cerebrovascular disease (CVD) through atheroembolism and hypoperfusion. If so, revascularization may slow progression of silent CVD. We aimed to compare the presence and severity of silent CVD to the degree of carotid bifurcation stenosis by cerebral hemisphere. MATERIALS AND METHODS: Patients age ≥40 years with carotid stenosis >50% by carotid ultrasound who underwent MRI brain from 2011-2015 at Mayo Clinic were included. Severity of carotid stenosis was classified by carotid duplex ultrasound as 50-69% (moderate), 70-99% (severe), or occluded. White matter lesion (WML) volume was quantified using an automated deep-learning algorithm applied to axial T2 FLAIR images. Differences in WML volume and prevalent silent infarcts were compared across hemispheres and severity of carotid stenosis. RESULTS: Of the 183 patients, mean age was 71±10 years, and 39.3% were female. Moderate stenosis was present in 35.5%, severe stenosis in 46.5% and occlusion in 18.0%. Patients with carotid stenosis had greater WML volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference, 0.42±0.21cc, p=0.046). Higher degrees of stenosis were associated with greater hemispheric difference in WML volume (moderate vs. severe; 0.16±0.27cc vs 0.74±0.31cc, p=0.009). Prevalence of silent infarct was 23.5% and was greater on the side of carotid stenosis than the contralateral side (hemispheric difference 8.8%±3.2%, p=0.006). Higher degrees of stenosis were associated with higher burden of silent infarcts (moderate vs severe, 10.8% vs 31.8%; p=0.002). CONCLUSIONS: WML and silent infarcts were greater on the side of severe carotid stenosis.

Hepatic Pseudolipoma: A Rare Case.

Pseudolipoma, also known as pseudolipoma of the Glisson's capsule, is an encapsulated lesion that contains degenerated fat and is enveloped by the liver capsule. In this report, we discuss a 37-year-old male presenting with dysuria and microscopic hematuria who revealed an incidental finding of a pseudolipoma on a CT scan of the abdomen.

A Rare Case of Small Bowel Obstruction Secondary to Pelvic Inflammatory Disease.

Small bowel obstruction (SBO) secondary to pelvic inflammatory disease (PID) is a rare complication only reported on a few occasions. We presented a 38-year-old female with an acute abdomen secondary to PID diagnosed via CT and MRI abdomen. The patient was treated in a conservative manner and recovered with no further complications. In our case, the learning point is the consideration of such an etiology in women with no previous surgical history presenting with an acute abdomen.