Assessing the Stress Echocardiography in Women With Breast Arterial Calcification.

Objective: breast arterial calcification (BAC) is one of the most prevalent mammographic findings and has been debated as a marker of cardiovascular disease (CVDs). The present study aimed to assess the findings of stress echo in women with BAC. Materials and methods: This cross-sectional study was conducted on women who undergo mammography for routine breast cancer screening at Imam Reza hospital, western Iran from March 2018 to July 2018. The patients underwent stress echocardiography to evaluate the probability of myocardial ischemia (MI). Chi-square and independent t-tests were used to assess the differences between subgroups. Results: BAC was present in 61 (15.2%) women. The mean age of the patients with BAC was significantly higher than the patients without BAC (58.59± 7.82 vs. 55.32±6.57, p =0.003). Prevalence rates of the menopause (88.5% vs. 71.1%, p=0.009), hypertension (29.5% vs. 17.7%, p=0.032), and hypercholesterolemia (24.6% vs. 13.0, p=0.018) were significantly higher in the patients with BAC compared to the patients without BAC. The prevalence rate of MI symptoms in the patients with BAC was equal to 24.6%. Significantly, more women with BAC were positive for myocardial ischemia compared to the women without BAC (24.6% vs. 8.5%, p<0.001). The prevalence rates of the diabetes mellitus, hypertension, hypercholesterolemia, and history of CVDs were significantly higher in the patients who were positive for MI. Conclusion: It was found that BACs are correlated with an increased occurrence rate of CVDs. Our results illustrated that the patients who were positive for MI were more plausible to be diabetic, hyperlipidemic, hypertensive, and having a history of CVDs.

Diagnostic value of doppler ultrasound indices of maternal renal interlobar vasculature in the prediction of preeclampsia.

We aimed to determine the diagnostic accuracy of maternal renal vasculature Doppler ultrasound indices in the prediction of preeclampsia. A total of 40 pregnant women with a gestational age of more than 20 weeks were included and followed. The pregnant women underwent a Doppler ultrasound examination to measure the resistance index (RI) of the interlobar arteries of right and left kidneys and the renal interlobar vein impedance index (RIVI). Of the included women, 15 patients developed preeclampsia based on clinical and laboratory criteria. The renal vascular Doppler ultrasound indices were compared between the two groups. Then, using the Receiver Operating Characteristic (ROC) analysis, the diagnostic accuracy of interlobar artery RI and RIVI were investigated in the prediction of preeclampsia occurrence. RIVI values of right and left kidneys were significantly higher in the preeclampsia group compared to the normal pregnancy group. The left kidney interlobar artery RI at a cut-point of 0.59 had a sensitivity of 100% and a specificity of 40% (area under curve=0.7, P-0.03) in the prediction of preeclampsia. The RIVI of the left kidney (adjusted odds ratio=17.14, 95% CI = 3.46 to 47.28) was statistically significant in predicting preeclampsia (P-0.006). We found that, besides other routine methods, using Doppler ultrasound and measuring RIVI can be reliable in the prediction of preeclampsia.

Brain magnetic resonance imaging findings in postpartum headache.

OBJECTIVES: The objectives were to determine the frequency of abnormal magnetic resonance imaging findings in patients with postpartum headache and related factors. METHODS: A total of 102 patients with postpartum headache underwent brain magnetic resonance imaging study. The images were examined by a blinded radiologist. The related demographic, obstetric and headache-related factors were recorded. The multiple logistic regression model was used to determine the predictive factors. RESULTS: Abnormal magnetic resonance imaging findings were observed in 42 of 102 patients (41.2%, 95% confidence interval = 31.6 to 50.7%). The most common finding was sinusitis (10 of 42 patients, 23.8%, 95% confidence interval = 15.5 to 32%). Then, posterior reversible encephalopathy syndrome (six of 42 cases, 14.2%, 95% confidence interval = 7.4 to 20.9%), cerebral venous thrombosis (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%), and subarachnoid hemorrhage (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%) were most prevalent findings. Convulsions (odds ratio of 3.39) and initiation of headache earlier than 5 days postpartum (odds ratio of 0.29) were significant predictive factors. CONCLUSION: Abnormal brain magnetic resonance imaging findings were seen in a considerable number of patients with postpartum headache. When headache starts in the first 5 days postpartum and accompanied by convulsions, there are likely to be abnormal magnetic resonance imaging findings.

Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging.

Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R2 = 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) - 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.

Primary multifocal myxopapillary ependymoma of the filum terminale.

BACKGROUND: Myxopapillary ependymoma (MPE) is a rare variant of ependymoma usually occurring in the conus medullaris or the filum terminale. It is usually a single encapsulated lesion. The aim of this study was to describe patients with primary multifocal MPE of the filum terminale. METHODS: In this retrospective study, medical records of 22 patients with spinal MPE who underwent surgical treatment in our hospital between January 2003 and January 2010 were enrolled. The study included 14 males and 8 females with age range from 11 to 66 years. There were 14 adult patients and 8 pediatric patients. The clinical presentation was low back pain (LBP), radiculopathy, focal neurological deficit and cranial nerve palsy. RESULTS: Four cases presented with primary multifocal MPE at the filum terminale. All of them had chronic LBP for at least 2-3 years. Three patients had lower extremity radiculopathy and one had urinary incontinence upon presentation. On magnetic resonance imaging (MRI), three patients presented with two lesions and one patient presented with three lesions at different spinal levels (a total of 9 MPEs). All lesions showed enhancement following gadolinium administration on MRI. For 6 tumors en bloc resection was performed. Three lesions were removed gross totally in a piece-meal fashion. Following the surgical management, no postoperative complication occurred. Three patients underwent radiotherapy (RT. On an average follow-up of 6 years with clinical and MRI imaging, no recurrence was detected and symptoms of LBP and neurologic findings improved after 2 months. CONCLUSIONS: Primary multifocal MPE is an extremely rare event occurring in the conus medullaris or filum terminale. The exact pathogenesis of this condition is unclear. Multifocal MPE may be due to multifocal growth of tumors, early stage of growth of a giant tumor or drop metastasis of tumor in the subarachnoid space. En bloc resection or piecemeal resection with radiotherapy were associated with satisfactory outcome without recurrence.

Adherence to Antihypertensives in Patients With Comorbid Condition.

BACKGROUND: Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications. OBJECTIVES: We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen. PATIENTS AND METHODS: Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews. RESULTS: The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions. CONCLUSIONS: With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

Controlled Blood Pressure in Iranian Patients: A Multi-Center Report.

We decided to determine the percentage of hypertensive patients whose blood pressure (BP) measurements were within recommended controlled range and to identify predictive factors for controlled BP. In this study carried out in 2014, 280 patients were included consecutively through sampling from both university and private medical centers/pharmacies in four Iranian cities. Demographic data as well as information about duration of HTN and prescribed medications, admission to emergency department (ED) because of HTN crisis, comorbidities, and control of HTN during the last 6 months by a healthcare provider were gathered. Adherence to anti-hypertensives was also determined using the validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Controlled BP was defined as systolic BP< 140 and diastolic BP< 90 mmHg in non-diabetics and < 130/80 mmHg in diabetics. Of 280 patients, 122 subjects (43.6%) had controlled BP. Among 55 diabetics, only two patients (3.6%) had controlled BP. Multiple logistic regression revealed the following variables as significant predictors of controlled BP: higher MMAS-8 score (adjusted odds ratio (OR)= 1.19, P= 0.03), fewer number of comorbid conditions (adjusted OR= 0.71, P = 0.03), having occupation as clerk/military personnel (adjusted OR= 1.03, P= 0.04), and not having history of ED admission during the last 6 months because of HTN crisis (adjusted OR= 2.11, P= 0.01). Considerable number of the studied patients had uncontrolled BP. Regarding the dramatic consequences of uncontrolled high BP in long term, it is advisable that careful attention by health care providers to the aforementioned factors could raise the likelihood of achieving controlled BP.

Calcified Mass on Brain CT in a Teenager with Refractory Seizures.

Cerebral echinococcosis is very rare, representing 2% of all cystic echinococcosis (CE) cases. Primary echinococcal cysts of the brain are extremely rare in pediatric patients. We report on a 16-year-old boy referred to our tertiary center with intractable epilepsy for the previous three years despite receiving full doses of three antiepileptic medications. Brain computed tomography (CT) showed a left frontal calcified mass. Magnetic resonance imaging (MRI) of the brain revealed a well-defined spherical mass in the left frontal lobe, slightly hypointense on T1-weighted and heterogeneous hyperintense on T2-weighted images with no contrast enhancement. With a broad differential list in mind, a surgical intervention was planned. During surgery, a primary calcified cerebral echinococcal cyst with severe adhesion to the adjacent dura of the frontal region was discovered and removed intact. Histopathology examination confirmed the diagnosis. Only phenobarbital was continued and no medical therapy for CE was administered. Two years after surgery, the patient remained free of seizures. In areas endemic for CE, cerebral echinococcal cyst should be included in the differential list of patients with intractable seizures. Though rare, this entity can present itself as a calcified mass on neuroimaging. Surgical removal of the calcified cyst is necessary for control and treatment of the epilepsy.

Disseminated intraspinal hydatid disease.

Spinal echinococcosis is a rare entity, accounting for 1% of all cases of hydatid disease. The authors report the case of a 60-year-old man whom they treated for recurrent nerve root compression due to disseminated intraspinal echinococcosis (hydatid disease). Six years previously he had undergone surgery on an emergency basis at another institution after presenting with acute paraplegia due to a primary extradural hydatid cyst of the thoracic spine. Unfortunately, during surgical removal of the cysts, the echinococcosis disseminated into the spinal canal. This complication was documented by magnetic resonance (MR) imaging. In the 4 years before the authors treated him, he was hospitalized 4 times for 4 recurrences of nerve root compression. The authors treated the disseminated disease successfully with total T7-8 corpectomy, grafting with titanium cage and Texas Scottish Rite Hospital instrumentation, and long-term administration of albendazole (400 mg daily). Early diagnosis, proper utilization of MR imaging, and radical resection of diseased vertebrae and soft tissues followed by anthelmintic treatment are essential to control disseminated spinal hydatidosis and prevent recurrence.