Virtual histology study of atherosclerotic plaque composition in patients with stable angina and acute phase of acute coronary syndromes without ST segment elevation

Introduction Rupture of vulnerable atherosclerotic plaques is the cause of most acute coronary syndromes (ACS). Postmortem studies which compared stable coronary lesions and atherosclerotic plaques in patients who have died because of ACS indicated high lipid-core content as one of the major determinants of plaque vulnerability. Objective Our primary goal was to assess the potential relations of plaque composition determined by IVUS-VH (Intravascular Ultrasound - Virtual Histology) in patients with stable angina and subjects in acute phase of ACS without ST segment elevation. Methods The study comprised of 40 patients who underwent preintervention IVUS examination. Tissue maps were reconstructed from radio frequency data using IVUS-VH software. Results We analyzed 53 lesions in 40 patients. Stable angina was diagnosed in 24 patients (29 lesions), while acute phase of ACS without ST elevation was diagnosed in 16 patients (24 lesions). In the patients in acute phase of ACS without ST segment elevation IVUS-VH examination showed a significantly larger area of the necrotic core at the site of minimal lumen area and a larger mean of the necrotic core volume in the entire lesion comparing to stable angina subjects (1.84±0.90 mm2 vs. 0.96±0.69 mm2; p3 vs. 11.54±14.15 mm3; p<0.05 respectively). Conclusion IVUS-VH detected that the necrotic core was significantly larger in atherosclerotic lesions in patients in acute phase of ACS without ST elevation comparing to the stable angina subjects and that it could be considered as a marker of plaque vulnerability

Is There Any Point in a Corticosteroid Treatment of Intermittent Asthma?

International guidelines advocate the early introduction of inhaled corticosteroids (ICS) in all types of persistent asthma. Our study was undertaken to assess the effects of ICS on bronchial hyperresponsiveness (BHR) as a hallmark of inflammation, and to assess the symptoms, the use of rescue medications, and the parameters of lung function in patients with mild intermittent asthma. The patients with intermittent asthma (n = 85) were randomly allocated to a treatment with ICS, beclomethasone dipropionate 250 μg/day and short-acting β2 agonists salbutamol as needed (Group A, n = 45) or to a treatment with only short-acting β2 agonists as needed (Group B, n = 40) during the 6-month treatment period. At the end of the study, in Group A, we found a statistically significant decrease of BHR (PD20 0.98 vs. 2.07) (p < 0.001), diurnal peak expiratory flow (PEF) variability (17.9 vs. 13.8) (p < 0.001), symptom scores (0.63 vs. 0.30) (p < 0.001), and used rescue medication (p < 0.001), while the parameters of lung function remained unchanged except for forced expiratory volume in 1 sec (FEV1), which had a statistically significant increase (3.58 vs. 3.66) (p < 0.001). In Group B, there was a statistically significant decrease of lung function parameters FEV1 (3.80 vs. 3.71) (p < 0.001), forced vital capacity (FVC) (4.43 vs. 4.37) (p < 0.001), FEV1/FVC (88.2 vs. 85.3) (p < 0.05), PEF (8.05 vs. 7.51) (p < 0.01), PEF variability (17.85 vs. 18.33) (p < 0.001), increased BHR (PD20 1.04 vs. 0.62) (p < 0.05), and symptom scores (0.46 vs. 0.62) (p < 0.01), as well as the use of rescue medication during the day (p < 0.001). Early introduction of low doses of ICS may be more beneficial than β2 agonists alone in patients with intermittent asthma

Difficulties in establishing a timely diagnosis of pulmonary artery sarcoma misdiagnosed as chronic thrombo-embolic pulmonary disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pulmonary artery sarcomas are rare neoplasms that are often confused with chronic thrombo-embolic disease, as both can have similar clinical and imaging presentation.</p> <p>Case presentation</p> <p>In this report, we present a case of a 50-year-old man initially diagnosed with chronic thrombo-embolic pulmonary disease, but who was later found to have pulmonary artery sarcoma with poor survival prognosis. We review the clinical and imaging characteristics of the two diseases and discuss the difficulties in establishing a timely diagnosis.</p> <p>Conclusion</p> <p>Similar clinical features and imaging presentation of pulmonary artery sarcoma and chronic thrombo-embolic pulmonary disease make definitive diagnosis difficult. This case report also illustrates and emphasizes that in any case with no predisposition factors for embolism, no evidence of deep venous thrombosis and pulmonary emboli, and inadequate relief of symptoms with anticoagulation, an alternative diagnosis of pulmonary artery sarcoma should be considered. If pulmonary artery sarcoma is diagnosed late in the course of the disease, there is usually a poor survival outcome.</p

Recycling and Reinforcing Intimomedial Flap of the infrarenal Aorta using Anterior Longitudinal Ligament in Patients with acute Trauma with Bowel Injuries

We present a patient with blunt abdominal trauma with severe acute right limb ischemia and clinical signs of diffuse peritonitis. Computed tomography angiography showed circumferential dissection of the infrarenal aorta with occlusion of the right common iliac artery. We opted for simultaneous abdomen exploration and open repair of injured aorta. Critical weakening of the aortic wall with imminent rupture was identified intraoperatively. Aortotomy cranially from bifurcation showed circumferential intimomedial dissection. The fixation of fragile intimomedial flap of aortic dissection was achieved with reinforcement using an anterior longitudinal ligament. The long aortoiliac arteriotomy was repaired using a great saphenous vein patch. Patient had uneventful postoperative course and was discharged after 7 days. In patients with abdominal polytrauma with peritonitis, and no available endovascular tools, open surgery for circumferential aortic dissection is possible and successful. Described reinforcement of the posterior aortic wall to the anterior longitudinal ligament should be added to the armamentarium of aortic injury treatment

Presentation of pericardial hydatid cyst as acute cardiac tamponade

We report a case of a 47-year-old man with isolated pericardial hydatid cyst (without myocardial involvement) that presented as acute pericardial tamponade. After initial investigation and transthoracic echocardiography, emergent pericardial drainage was performed for downgrading the urgency of a definitive treatment for a hydatid cyst. A computed tomography examination after the pericardial drainage showed a pericardial cyst without heart muscle involvement, making the treatment possible through anterior thoracotomy and without performing cardiopulmonary bypass. Complete surgical removal of the cyst was performed. The postoperative course was uneventful. The patient received postoperative albendazole treatment. He remained asymptomatic and no recurrence was observed during a 1-year follow-up period

WEGENER GRANULOMATOSIS- CASE REPORT

Wegener granulomatosis is uncommon multisystemic disease, characterized by necrotizing granulomatous inflammation of the upper and lower respiratory tracts and general focal necrotizing vasculitis (Commonly known as „Wegener's triad“). The lungs are involved in 72 per cent of patients and the clinic and radiographic findings indicated bilateral pulmonary nodules of varying size and definition, cavitated in half of the patients, accompanied by the nodular lesion with a rare involvement of the pleura.We described a case of 62-year-old women with pansinusitis, mild azotemia and initial respiratory tract symptoms such as chronic cough and occasional hemoptysis. Due to bilateral nodular infiltrates in lungs on chest radiogram she was initially treated for smear negative pulmonary tuberculosis, but without expected antituberculous response. An additional diagnostic procedure pointed to Morbus Wegener.Two patterns of ANCA positive immunofluorescence are recognized as reliable and valuable diagnostic tools in the absence of histopathology for the diagnosis of Wegener granulomatosis

Zyxin expression levels in non-small cell lung cancer patients

© 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved. Background/Aim. Non-small cell lung cancer (NSCLC) is the most common cause of cancer-related mortality worldwide. Early detection represents one of the most promising approaches to reduce lung cancer mortality. Zyxin (ZYX) is a member of the focal adhesion protein family, recently identified as a potential early diagnostic marker for NSCLC. The aim of this study was to evaluate ZYX expression levels in NSCLC patients and compare its serum expression profiles between early and advanced clinical stages, different histological subtypes and histological grades. Methods. Blood samples were obtained from 90 patients diagnosed with NSCLC in all clinical stages and 30 patients without the clinical and radiological findings and previous history of malignancy. For the quantitative determination of human ZYX concentrations in the serum we used enzyme-linked immunoadsorbent assay (ELISA). Results. ZYX exhibited higher serum levels in NSCLC patients as compared to the control samples with exceptionally significant difference (p = 0.00). The ROC curve demonstrated a high specificity with AUC = 0.912. There were no statistically significant differences in the ZYX values between two most common NSCLC types, adenocarcinoma and squamous cell carcinoma (p = 0.758). There were no statistically significant differences in the ZYX values among different clinical stages (p = 0.518). Only 3 patients had well-differentiated tumor, and no useful data may be extracted from their samples. There were no statistically significant differences in the ZYX values between patients with moderately differentiated tumor and poorly differentiated tumor (p = 0.48). Conclusion. We found that ZYX was overexpressed in NSCLC, but its expression level was not closely correlated with the tumor size and advanced tumor, node, metastasis (TNM) stage. Our results suggest that ZYX has potential to be an early diagnostic plasma-based tumor marker for NSCLC with the same importance for both adenocarcinoma and squamous cell carcinoma

Original articlesThe prevalence of potentially unstable coronary lesions in patients with coronary artery disease &#8211; virtual histology study

Background: Histopathological studies indicate that coronary artery lesions with a thin fibrous cap and large necrotic core (thin-cap fibroatheromas, TCFA) are characterised by a high risk of rupture and can potentially trigger acute coronary syndrome (ACS). Atherosclerotic lesions with a well preserved fibrous cap (fibroatheromas, FA) are considered to be more stable ones. Intravascular ultrasound virtual histology (IVUS-VH) enables identification of FA and TCFA in vivo. There are no published data regarding IVUS-VH derived occurrence of both FA and TCFA in patients with different clinical presentation. Aim: To determine IVUS-VH derived occurrence of FA and TCFA in coronary arteries of patients with chronic stable angina in comparison with recent or acute ACS subjects. Methods: Intravascular ultrasound examination was performed in 60 patients, who were prospectively enrolled to three groups: group A &#8211; chronic stable angina, without a history of ACS within the previous 12 months; group B &#8211; recent ACS (4 weeks &#8211; 3 months); group C &#8211; acute phase of ACS. Results: The final analysis included 75 non-culprit lesions (group A: n=29 lesions; group B: n=22; group C: n=24). There were no significant differences in lesions&#8217; angiographic and ultrasound characteristics between the studied groups. There was no significant difference in the occurrence of FA lesions between the studied groups (20.7 vs. 22.7 vs. 4.2, respectively; NS). There was a significant difference in TCFA occurrence between the studied groups (31.0 vs. 50.0 vs. 79.2%; pWstęp: Jak wynika z badań histopatologicznych, pęknięcie blaszki miażdżycowej jest najczęstszą przyczyną występowania ostrych zespołów wieńcowych (ACS). Blaszka miażdżycowa z cienką czapeczką łącznotkankową (ang. thin-cap fibroatheroma, TCFA) została zidentyfikowana jako zmiana charakteryzująca się wysokim ryzykiem destabilizacji, podczas gdy blaszka z zachowaną czapeczką łącznotkankową (ang. fibroatheroma, FA) uważana jest za zmianę o mniejszym ryzyku pęknięcia. Wirtualna histologia (ang. intravascular ultrasound &#8211; virtual histology, IVUS-VH) jest metodą diagnostyczną pozwalającą na identyfikację zmian o morfologii TCFA i FA w warunkach przyżyciowych. Dotychczas nie ma jednoznacznych danych dotyczących występowania tego typu zmian w tętnicach pacjentów z różnymi postaciami choroby wieńcowej. Cel: Ustalenie częstości występowania zmian o morfologii TCFA i FA w tętnicach wieńcowych pacjentów ze stabilną chorobą wieńcową, chorych z ACS w wywiadzie i chorych w fazie ostrej ACS. Metodyka: Badaniu metodą IVUS-VH poddano 60 chorych. Grupę A stanowiły osoby z rozpoznaną stabilną chorobą wieńcową bez wywiadu ACS w czasie ostatnich 12 mies. Do grupy B kwalifikowano chorych z przebytym ACS, który wystąpił w czasie ostatnich 4 tygodni do 3 mies. poprzedzających badanie. W grupie C znalazły się osoby poddawane badaniu w ostrej fazie ACS. Wyniki: Ostatecznej analizie poddano 75 zmian miażdżycowych w tętnicach wieńcowych (grupa A n=29 zmian; grupa B n=22; grupa C n=24). Pomiędzy badanymi grupami nie stwierdzono różnic w charakterystyce angiograficznej i ultrasonograficznej. Nie odnotowano także istotnych różnic w częstości występowania zmian o morfologii FA (20,7 vs 7 vs 4,2%, odpowiednio grupa A, B i C; NS). Obserwowano istotną zależność pomiędzy rozpoznaniem klinicznym a występowaniem zmian o morfologii TCFA, największą częstość tego typu zmian stwierdzono w grupie C (31,0 vs 50,0 vs 79,2%, odpowiednio;

Assessment and Prediction of Adherence to Methotrexate Using Three Self-Report Questionnaires in Patients with Rheumatoid Arthritis

Introduction: Methotrexate (MTX) reduces rheumatoid arthritis activity and ameliorates the long-term functional status in these patients. To achieve this aim, patients need to take their medication regularly. Nevertheless, non-adherence to MTX still remains a considerable issue in the management of rheumatoid arthritis. Objective: This study aimed to estimate the adherence to methotrexate in patients with rheumatoid arthritis and to identify specific non-adherence risk factors. Methods: A cross-sectional study included 111 patients (mean age 56.2 ± 10.6 years, 78.4% female, and mean disease duration 6 years (3–13)). Three adherence self-assessment questionnaires were used: the Compliance-Questionnaire-Rheumatology (CQR19), the Medication Adherence Reports Scale (MARS-5), and the Visual Analogue Scale (VAS). We also collected demographic data, disease and treatment characteristics, and anxiety/depression estimation results (Hospital Anxiety and Depression Scale, HADS). Results: Adherence was identified in 48.6% of patients (COR19), 70.3% of patients (MARS-5), and 82.9% of patients (VAS questionnaire). All three questionnaires displayed a significant positive mutual correlation: CQR19 with MARS-5 and VAS (r = 0.364, r = 0.329, respectively, p p p = 0.030) using the MARS-5, female sex (0.264 (0.095–0.730), p = 0.010) according to the CQR19, and for a dose of methotrexate (0.881 (0.783–0.992), p = 0.036) using the VAS, while negative predictions were shown for comorbidity number (3.062 (1.057–8.874), p = 0.039) and depression (1.142 (1.010–1.293), p = 0.035) using the MARS-5 and for older age (1.041 (1.003–1.081), p = 0.034) according to the CQR19. The use of steroids was a significant positive predictor in all three questionnaires and remained an independent predictor for methotrexate adherence in the multivariate logistic regression. Conclusions: We showed non-adherence to methotrexate in a significant number of patients using all three questionnaires. Concomitant steroid therapy emerged as an independent positive predictor for adherence