Cardiovascular risk factors associated with coronary ectasia and acute myocardial infarction.

INTRODUCTION: Coronary ectasia has a low prevalence in the general population. Its risk factors may differ from those of coronary artery disease. OBJECTIVE: To identify the prevalence of coronary ectasia in patients with acute myocardial infarction (AMI) and cardiovascular risk factors (CVRFs). METHODS: Retrospective, cross-sectional study. Out of 3,254 cardiac catheterizations for AMI during one year, 2,975 had no coronary ectasia. We included 558 patients with coronary ectasia on coronary angiography and, as controls, subjects with similar characteristics except for coronary ectasia, and CVRFs were recorded. Descriptive statistics, bivariate and multivariate analysis were used; odds ratio (OR) was calculated. RESULTS: 279 patients with and without coronary ectasia were studied. The prevalence of coronary ectasia was 8.5 %. The platelet/lymphocyte ratio (PLR) was higher in patients with ectasia than in those without ectasia (p = 0.003). In the bivariate analysis, associated CVRFs were overweight, obesity and diabetes, and in the multivariate analysis, hypercholesterolemia (OR: 3.90; p = 0.0001) and exposure to herbicides (OR: 6.82; p = 0.020). CONCLUSIONS: A high prevalence of coronary ectasia was found, with the main risk factors being a history of herbicide use and hypercholesterolemia. PLR was found to be elevated in these patients. Early detection is important due to its association with acute coronary events.

INTRODUCCIÓN: La ectasia coronaria tiene baja prevalencia en población general, los factores de riesgo pueden diferir de la enfermedad arterial coronaria. OBJETIVO: Identificar la prevalencia de ectasia coronaria en pacientes con infarto agudo de miocardio (IAM) y factores de riesgo cardiovascular (FRCV). MÉTODOS: Estudio retrospectivo, transversal. De 3,254 cateterismos cardiacos por IAM durante un año, 2,975 no presentaron ectasia coronaria. Se incluyeron 558 pacientes clasificados como portadores de ectasia coronaria en coronariografía y controles aquellos con características similares exceptuando la ectasia coronaria y se registraron los FRCV. Empleamos estadística descriptiva, análisis bivariante, multivariante y calculamos el odds ratio (OR). RESULTADOS: Se estudiaron 279 pacientes con y sin ectasia coronaria. La prevalencia de ectasia coronaria fue del 8.5%. El índice plaqueta/linfocito (IPL) se encontró más elevado en pacientes con ectasia que en aquellos sin ectasia (p = 0.003). En el análisis bivariante los FRCV asociados fueron sobrepeso, obesidad y diabetes, y en el multivariante la hipercolesterolemia (OR: 3.90; p = 0.0001) y exposición a herbicidas (OR: 6.82; p = 0.020). CONCLUSIONES: Encontramos alta prevalencia de ectasia coronaria, los principales factores de riesgo fueron el antecedente de uso de herbicidas e hipercolesterolemia. Identificamos el IPL elevado en estos pacientes. Es importante la detección oportuna debido a su asociación con eventos coronarios agudos.

Vessel/perfusion density in two optical coherence tomographic angiography protocols: Interchangeable?

INTRODUCTION: Different optical coherence tomography angiography (OCTA) scanning protocols evaluate the macula. OBJECTIVE: To compare the determination coefficients (R2) between vessel and perfusion densities of two OCTA scanning protocols in order to determine if their metrics could be interchanged. METHOD: Cross-sectional, prospective, comparative, observational, study between two OCTA scanning protocols (Angioplex, Zeiss) in healthy subjects. The R2 between central, inner, and full densities (3 x 3 mm protocol) and between central, inner, outer and full densities (6 x 6 mm protocol) was identified, both for vessel and perfusion densities. RESULTS: Seventy-eight eyes were evaluated; subjects' median age was 23 years. There were high R2 between inner and full densities with the 3 x 3 mm protocol (0.96), between outer and full densities with the 6 x 6 mm protocol (0.96), and between central vessel and perfusion densities (≥ 0.96); R2 between central vessel and perfusion densities of different protocols was ≤ 0.71. CONCLUSIONS: Vessel and perfusion densities have high determination coefficients within a scanning protocol, but not between protocols, given that each one preferentially measures different macular areas. Metrics from different protocols should not be interchanged for follow up.

INTRODUCCIÓN: Distintos protocolos de angiotomografía de coherencia óptica evalúan la mácula. OBJETIVO: R2 entre las densidades vascular y de perfusión de dos protocolos de angiotomografía de coherencia óptica, para determinar si sus mediciones podían intercambiarse. MÉTODO: Estudio observacional, comparativo, prospectivo, transversal entre dos protocolos de angiotomografía de coherencia óptica (AngioPlex, Zeiss) en sujetos sanos. Se identificó la R2 entre las densidades vascular y de perfusión central, interna y completa (protocolo de 3 x 3 mm), y central, interna, externa y completa (protocolo de 6 x 6 mm). RESULTADOS: 78 ojos, mediana de edad 23 años. Hubo R2 altas entre las densidades interna y completa del protocolo de 3 x 3 mm (0.96), externa y completa del de 6 x 6 mm (0.96), y centrales vasculares y de perfusión (≥ 0.96); la R2 entre las densidades centrales vascular y de perfusión de distintos protocolos fue ≤ 0.71. CONCLUSIONES: Las densidades vasculares y de perfusión tienen R2 alta dentro de un protocolo, pero no entre protocolos, porque estos miden preferentemente zonas distintas, lo cual limita intercambiar mediciones.

Regional parafoveal vessel density changes in diabetic patients without retinopathy.

INTRODUCTION: Regional parafoveal vessel density changes have not been characterized in patients with type 2 diabetes without retinopathy. OBJECTIVE: To compare regional changes in vessel density between subjects without diabetes (group 1) and with diabetes without retinopathy (group 2). METHODS: Observacional, retrospective, cross-sectional, comparative study. Parafoveal vessel density by quadrants was compared between groups and between quadrants in each group; density of each quadrant and inner density were correlated, as well as the contribution of each quadrant to inner density (linear regression). RESULTS: Thirty-four eyes were analyzed in group 1 and 38 in group 2; in the latter, inner vessel density (20.75 vs. 21.85, p = 0.021) and that of superior quadrants (21.05 vs. 21.75, p < 0.001), and nasal quadrants (20.95 vs. 21.50, p = 0.023) were lower. In the regression analysis, superior and nasal quadrants had the largest contribution to the change in inner vessel density in group 2 (b = 0.361 and b = 0.294, respectively). CONCLUSIONS: Parafoveal inner vessel density decreases in diabetic patients without retinopathy at the expense of superior and nasal quadrants, which indicates that further evaluation is required for early microvascular disease to be detected.

INTRODUCCIÓN: Los cambios regionales de densidad vascular parafoveal no han sido caracterizados en los pacientes con diabetes tipo 2 sin retinopatía. OBJETIVO: Comparar los cambios regionales de densidad vascular entre sujetos sin diabetes (grupo 1) y con diabetes sin retinopatía (grupo 2). MÉTODOS: Estudio observacional, retrospectivo, transversal y comparativo. La densidad vascular parafoveal por cuadrantes se comparó entre grupos y entre cuadrantes en cada grupo; se correlacionó la densidad de cada cuadrante y la densidad interna, así como la contribución de cada cuadrante a la densidad interna (regresión lineal). RESULTADOS: Se analizaron 34 ojos en el grupo 1 y 38 en el grupo 2; en este fue menor la densidad vascular interna (20.75 versus 21.85, p = 0.021) y la de los cuadrantes superior (21.05 versus 21.75, p < 0.001) y nasal (20.95 versus 21.50, p = 0.023). En el análisis de regresión, los cuadrantes superior y nasal tuvieron la mayor contribución al cambio en la densidad vascular interna (b = 0.361, b = 0.294) en el grupo 2. CONCLUSIONES: La densidad vascular interna parafoveal disminuye en los pacientes diabéticos sin retinopatía, a expensas de los cuadrantes superior y nasal, por lo que se requiere evaluación adicional para detectar afecciones microvasculares tempranas.

[Carotid body tumor and its treatment. A case report]. / A glomus caroticum paragangliomája és ellátása.

Our goal was to report a 44-year-old woman with carotid body tumor, and to give a brief and comprehensive presentation about the disease and summarize its complex management. Carotid body tumor is a rare, mostly sporadic, benign head and neck mass originating from the glomus caroticum. It occurs mostly in middle-aged women as a slowly growing, semifix, painless neck mass. The diagnosis is based upon the physical examination (pulsatile mass, Fontaine-sign) and - as the gold standard - CT-angiography. It should be established that preoperative embolisation by digital substraction angiography plays a crucial role in the treatment of carotid body tumors that should be followed by surgical removal. In case of inoperable/irresecable and residual tumors, radiotherapy is the treatment option. The patient was treated in our department in April 2017. Orv Hetil. 2018; 159(36): 1487-1492.

[Evaluation of diabetic microangiopathy using optical coherence tomography angiography]. / Diabeteses kisér-károsodás vizsgálata optikai koherencia tomográfián alapuló angiográfiával.

INTRODUCTION: Optical coherence tomography angiography is a non-invasive imaging technique that is able to visualize the different retinal vascular layers using motion contrast to detect blood flow without intravenous dye injection. This method might help to assess microangiopathy in diabetic retinopathy during screening and follow-up. AIM: To quantify retinal microvasculature alterations in both eyes of diabetic patients in relation to systemic risk factors using optical coherence tomography angiography. METHOD: Both eyes of 36 diabetic patients and 45 individuals without diabetes were examined. Duration of diabetes, insulin therapy, blood pressure, HbA1c, dyslipidemia, axial length and the presence of diabetic retinopathy were recorded. Retinal vessel density was measured by optical coherence tomography angiography. The effect of risk factors on vessel density and between-eye asymmetry was assessed using multivariable regression analysis. RESULTS: Vessel density was significantly lower and between-eye difference was significantly higher in diabetic patients compared to controls (p<0.05). Both vessel density and between-eye asymmetry significantly correlated with diabetes duration (p<0.05) after controlling for the effect of risk factors. The between-eye asymmetry in vessel density was significantly higher in patients without clinically detectable diabetic retinopathy compared to control subjects (p<0.001). CONCLUSIONS: There is a decrease in retinal vessel density and an increase in between-eye asymmetry in patients with diabetes compared to healthy subjects. By using optical coherence tomography angiography, the detection of these microvascular alterations is possible before clinically detectable diabetic retinopathy and might serve as a useful tool in both screening and timing of treatment. Orv Hetil. 2018; 159(8): 320-326.

[The spontaneous recanalization of the internal carotid artery. Case report]. / Az arteria carotis interna spontán rekanalizációja.

The occlusion of the internal carotid artery (ICA) frequently leads to stroke and develops most commonly as a consequence of embolism or atherosclerotic thrombosis. Following acute care, if the patient's general condition makes it possible, the patient is usually emitted from the hospital or, if necessary, his treatment continues in the rehabilitation department. The occlusion is generally considered irreversible, but a regular duplex ultrasonographic (sometimes CT angiographic) check of the patient is required. According to recent literature, spontaneous recanalization of the ICA may occur occasionally. The authors demonstrated by evaluating a local case that ICA occlusion is not necessarily permanent: through a case of a 67-year-old man, who suffered a right ICA occlusion, subsequent ichaemic stroke, then spontaneous recanalization of the occlusion allowing a successful endarterectomy later on, they overview the literature and propose appropriate prospective examinations to track patents with similar conditions. Orv Hetil. 2018; 159(37): 1525-1528.

Angio-OCT de la zona avascular foveal en ojos con oclusión venosa de la retina.

Objetivo: El objetivo del estudio comprendía visualizar y cuantificar las alteraciones patológicas de la zona avascular foveal (ZAF) mediante angio-OCT en ojos con oclusión venosa de la retina (OVR) en comparación con el ojo contralateral sano. Procedimientos: La angio-OCT se llevó a cabo mediante el sistema Avanti® RTVue 100 XR (Optovue Inc., Fremont, Calif., EE. UU.). Los bordes de la capa vascular superficial (CVS) se definieron como 3 µm por debajo de la membrana limitante interna y 15 µm por debajo de la capa plexiforme interna y, para la capa vascular profunda (CVP), como 15 y 70 µm por debajo de la membrana limitante interna y de la capa plexiforme interna, respectivamente. La longitud de la ZAF horizontal, vertical y máxima de la CVS y la CVP en cada ojo se midió de forma manual. Además, se midió el ángulo entre el diámetro máximo de la ZAF y el plano papilomacular. Resultados: La angio-OCT representó los defectos dentro de la vasculatura en el área perifoveal en ojos con oclusión de rama venosa de la retina (ORVR; n = 11) y con oclusión de la vena central de la retina (OVCR; n = 8). Esto resultó en un crecimiento del diámetro máximo de la ZAF en ojos con OVR (n = 19) en comparación con el ojo contralateral (n = 19; 921 ± 213 frente a 724 ± 145 µm; p = 0,008). Además, se observó una correlación significativa entre la mejor agudeza visual corregida (MAVC) y el diámetro máximo de la ZAF en la CVP (ρ de Spearman = -0,423, p < 0,01). Por último, en los ojos con OVR, el ángulo entre el plano papilomacular y el diámetro máximo de la ZAF se dio tan solo en el 21,05% (CVS) y en el 15,79% (CVP) de los casos a 0 ± 15 ó 90 ± 15°, respectivamente. En ojos sanos, estos ángulos (que supuestamente representan una configuración de la ZAF regular) fueron más prevalentes (CVS 68,42 frente a 21,05%, p = 0,003; CVP 73,68 frente a 15,79%, p < 0,001). Conclusiones: La angio-OCT muestra alteraciones morfológicas de la ZAF en ojos con OVCR y ORVR. La correlación del diámetro máximo de la ZAF con la MAVC indica que estas alteraciones resultan funcionalmente relevantes.

[Computer tomography examination of the coronary system - National Plaque Registry and Database, Hungary]. / A coronariarendszer komputertomográfiás vizsgálata ­ Országos Plakk Regiszter és Adatbázis (OPeRA).

INTRODUCTION AND AIM: Coronary computer tomography angiography is a unique non-invasive imaging technique with the capability to provide information regarding plaque quantity, burden and structure. A reliable registry is required to use the data of these examinations in research projects. The difficulty is that registries need double data entry simultaneously to the hospital information system. METHOD: Our registry solves this problem through a structured reporting tool, which generates clinical report and stores all data simultaneously. The automatically generated report is based on international guidelines. RESULTS: Between August 1. 2014 and September 1. 2015 we registered the data of 2866 patients. Coronary plaque was observed in 77.03% of the patients, 33.18% of the plaques were calcified. Severe stenosis was present in 13.71% of the patients. CONCLUSIONS: The structured reporting decreases reporting time, eliminates double data entry related errors. Our goal is to initiate a nationwide, unified registry, the National Plaque Registry and Database. Orv. Hetil., 2017, 158(3), 106-110.

Is urgent CT angiography necessary in cases of acute lower gastrointestinal bleeding? / ¿Es necesario realizar una angiografía por tomografía computarizada urgente en la hemorragia digestiva baja aguda? Proyecto MAPAC-IMAGEN.

Acute lower gastrointestinal bleeding usually presents as hematochezia, rectal bleeding or melena and represents 1-2% of the medical appointments in the Emergency Services. Mortality reaches the 30-40% and it is highly related with the severity and associated comorbidity. Most clinical practice guidelines include colonoscopy at some point in the diagnostic and therapeutic process (urgent for severe cases and ambulatory for mild ones) and look for predictors of severity. In the last years, there have been numerous studies where is clear the relevance and complementarity of advanced diagnostic imaging techniques, gradually incorporated as an alternative or second step in severe cases. Therefore, we have made a review of current scientific evidence to establish a clinical prediction rule for optimal indication of CT angiography in these patients. However, future studies providing greater robustness and level of evidence are necessary.

Algorithm for the diagnosis and follow-up of acute pulmonary embolisms. / Algoritmo para el diagnóstico y el seguimiento de la tromboembolia pulmonar aguda.

The urgent diagnosis of acute pulmonary thromboembolism benefits from the use of evidence-based clinical guidelines that improve patients' prognoses and reduce the unnecessary use of imaging tests. This article explains the diagnostic algorithms for pulmonary thromboembolism most recently published by the relevant scientific societies both for the general population and for special situations, trying to clear up common doubts and analyzing persistent controversies. It also discusses the need to follow up the thromboembolism after anticoagulation treatment, which is not currently recommended in the guidelines.

[Angiography of the ocular fundus without dye: Optical coherence tomography based angiography in exsudative age-related macular degeneration]. / Szemfenéki érfestés festék nélkül: Az optikai koherencia tomográfia alapú angiográfia exsudativ típusú idoskori maculadegenerációban.

INTRODUCTION: Vascular endothelial growth factor antibody therapy is an established treatment of exsudative age-related macular degeneration. AIM: The morphologic characterisation of the macular microvasculature after longstanding treatment. METHOD: Forty-eight patients (34 women and 14 men; age, 74.4 ± 8.0 years) were enrolled in the study. During follow-up time (53.8 ± 31.0 months), 7.6 ± 4.9 injections were administered in 56 eyes. Optical coherence tomography angiographic examination was performed with AngioVue (Optovue Inc. Fremont, CA, USA). RESULTS: Distortion of the superficial retinal plexus and foveal avascular zone enlargement were noted in 5/56 eyes, deep retinal plexus defect was detected in 9/56 cases. Destruction of the choriocapillaries and the former neovascularisation could be found in 4 different patterns: 1. pigment epithelium and choriocapillary atrophy, 2. submacular scar, 3. active leaking choroidal neovascularisation, 4. intraretinal cysts. CONCLUSION: Optical coherence tomography angiography is a novel non-invasive method, which enables the follow up of macular degeneration. Orv. Hetil., 2016, 157(42), 1683-1690.

[Masywne krwawienie z jelita malego: nowa opcja terapeutyczna z lokalizacja microcoil i laparoskopowa resekcja].

Masywne krwawienie z przewodu pokarmowego prezentuje kompleksowy problem diagnostyczny i terapeutyczny. Dokladna identyfikacja miejsca krwawienia jest skomplikowana i chirurgiczna resekcja miejsca krwawienia jest trudne. Angiografii uzywanej do lokalizacji i embolizacji miejscu krwawienia w krazeniu krezkowym brakuje skutecznosci ze wzgledu na skomplikowana siec zespolenia naczyn krwionosnych zaopatrujacych jelito cienkie. Przedoperacyjnie umieszczenie microcoil dla fluoroskopowo kierowanej laparoskopowej resekcji jelita cienkiego zostalo wykorzystane w przypadku 58-letniej kobiety leczonej chemioterapia z uzyciem idarubicyny i cytarabiny. Pacjentka miala krwawienie z przewodu pokarmowego, ktore nie reagowalo na leczenie zachowawcze i wymagalo masywnych transfuzji produktow krwi.

[Multiple intracranial arteriovenous malformation]. / Malformación arteriovenosa intracraneal múltiple.

Multiple cerebral arteriovenous malformations (AVMs) are thought to be exceedingly rare lesions and have usually been reported as single cases. The incidence of multiple cerebral AVMs in major series ranges from 0.3% to 9% and, in the majority of cases, these malformations are associated with other vascular anomalies of the brain or soft tissues. We report a 62-year-old woman that presented with a left temporal haemorrhage. Angiography showed 3 AVMs located in the left temporal lobe, left cerebellar hemisphere and right temporal lobe. The lesions were treated with radiosurgery.

[Quality of 3D magnetic resonance imaging of coronary arteries in patients with D-transposition of the great arteries after the Jatene switch procedure]. / Calidad de la coronariografía 3D por resonancia magnética en los pacientes con D-transposición de las grandes arterias intervenidos con switch arterial de Jatene.

OBJECTIVES: To evaluate the quality of images obtained with 3D balanced fast-field echo whole heart (WH3D) MRI sequences for assessing the coronary anastomosis and coronary stenosis in patients with D-transposition of the great arteries who have undergone the Jatene switch procedure. MATERIAL AND METHODS: We retrieved 100 WH3D studies done in 83 patients who had undergone the Jatene switch procedure from our pediatric cardiac MRI database; 84 of these studies fulfilled the criteria for inclusion in the study. We evaluated coronary stenoses on WH3D MR images and their correlation with coronary CT or angiography images. We retrospectively studied the quality of the images of the proximal coronary arteries using a four-point scale and correlating the findings with age, heart rate, and heart size. RESULTS: Of the 84 studies, 4 (4.8%) were of a quality considered «insufficient for diagnosis¼, 7 (8.3%) were considered «fair¼, 23 (27.4%) «good¼, and 50 (59.5%) «excellent¼. The quality of the image of the coronary arteries was significantly correlated with heart rate. MRI detected stenosis in the origin of the coronary arteries in 9 (10.7%) studies. CONCLUSION: Images obtained with the WH3D MRI sequence in patients who had undergone the Jatene procedure were of diagnostic quality in most cases and were better in patients with lower heart rates. In 10.7%, stenosis in the origin of the coronary arteries that required new studies was detected.

Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma.

The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.

A practical introduction to the hemodynamic analysis of the cardiovascular system with 4D Flow MRI.

The 4D Flow MRI technique provides a three-dimensional representation of blood flow over time, making it possible to evaluate the hemodynamics of the cardiovascular system both qualitatively and quantitatively. In this article, we describe the application of the 4D Flow technique in a 3T scanner; in addition to the technical parameters, we discuss the advantages and limitations of the technique and its possible clinical applications. We used 4D Flow MRI to study different body areas (chest, abdomen, neck, and head) in 10 volunteers. We obtained 3D representations of the patterns of flow and quantitative hemodynamic measurements. The technique makes it possible to evaluate the pattern of blood flow in large and midsize vessels without the need for exogenous contrast agents.

Update on cardiac imaging: A critical analysis.

Imaging is instrumental in diagnosing and directing the management of atherosclerosis. In 1958 the first diagnostic coronary angiography (CA) was performed, and since then further development has led to new methods such as coronary CT angiography (CTA), optical coherence tomography (OCT), positron tomography (PET), and intravascular ultrasound (IVUS). Currently, CA remains powerful for visualizing coronary arteries; however, recent studies show the benefits of using other non-invasive techniques. This review identifies optimum imaging techniques for diagnosing and monitoring plaque stability. This becomes even direr now, given the rapidly rising incidence of atherosclerosis in society today. Many acute coronary events, including acute myocardial infarctions and sudden deaths, are attributable to plaque rupture. Although fatal, these events can be preventable. We discuss the factors affecting plaque integrity, such as increased inflammation, medications like statins, and increased lipid content. Some of these precipitating factors are identifiable through imaging. However, we also highlight significant complications arising in some modalities; in CA this can include ventricular arrhythmia and even death. Extending this, we elucidated from the literature that risk can also vary based on the location of arteries and their plaques. Promisingly, there are less invasive methods being trialled for assessing plaque stability, such as Cardiac Magnetic Resonance Imaging (CMR), which is already in use for other cardiac diseases like cardiomyopathies. Therefore, future research focusing on using imaging modalities in conjunction may be sensible, to bridge between the effectiveness of modalities, at the expense of increased complications, and vice versa.

Internal carotid artery bulb width: a novel potential parameter for the prediction of cerebral vascular diseases.

OBJECTIVE: To investigate the relationship between the width of the internal carotid artery (ICA) bulb and cerebral vascular diseases including stroke and intracranial aneurysms. MATERIAL AND METHODS: In total 300 patients who had supra-aortic computed tomography angiography (CTA) were enrolled in this study from 2015 to 2021. The study groups consisted of 100 ischemic stroke patients, 100 patients with intracranial aneurysms, and 100 control subjects. The intracranial aneurysm patient group was divided into two subgroups according to the presence of subarachnoid hemorrhage (SAH). The largest diameters of the ICA C1 (cervical) and C2 (petrous) segments in all individuals were measured bilaterally on CTA images. The ICA diameter ratios of the cases were measured using the formula C1-C2C1. The relationship between the age and ICA vessel analysis was evaluated as well. RESULTS: The mean ICA bulb width values in the ischemic stroke patient group and the intracranial aneurysm patient group were significantly higher than the control group (p < 0.001). The ICA C1 and C2 segment diameter values and ICA diameter ratio were smaller in the intracranial aneurysm patients with SAH than those who had not (p = 0.7). There was a statistically significant but weak relationship between the age and ICA diameter ratios in all study groups (R-squared value of 0.26, p = 0.03). CONCLUSION: ICA bulb width is a parameter that can be easily evaluated with neuroimaging modalities and is a successful method that may be used for predicting the risk of ischemic stroke or the presence of an intracranial aneurysm.

Dysfunctioning mechanical mitral valve prosthesis: When thrombus over pannus makes hinders diagnosis.

Prosthetic valve obstruction is a rare but potentially lethal complication. The most frequent causes are thrombus and pannus formation, in the absence of infectious data. Diagnosis is not always easy using cardiac CT scanning and in 46%-85% of cases thrombus and pannus coexist, complicating the diagnosis. A rapid diagnosis is essential to avoid a fatal outcome of this pathology whose mortality, despite correct treatment, is high.

Woman with vigorexia experiencing severe bilateral vision loss.

We describe a 28-year-old Caucasian female with vigorexy, who had no previous ocular history. She presented with bilateral gradual painless reduction in vision over the past 3 weeks. She had been taking niacin supplements, averaging 500 mg daily, for 7 years. Fundus examination revealed bilateral CME, which was confirmed by ocular coherence tomography scan. Fundus fluorescein angiography did not reveal any fluid leakage. Niacin supplementation was discontinued, and after 2 months, the CME had completely resolved, and the best corrected visual acuities improved to 1 in both eyes.