Breast artery calcification as a predictor of coronary artery calcification : a cross-sectional study

Introduction: Coronary artery disease is the main cause of burden of disease in the world. Coronary calcification is seen as an aetiopathological event in the pathogenesis of cardiovascular diseases. Studies have shown that breast artery calcification, which is routinely found in mammography of elderly women, could be predictive of coronary artery calcification. Material and methods: In this cross-sectional study, 60 women over 40 years of age were included. All of these patients had undergone mammography after having an indication to undergo a computed tomography-angiography. Breast arterial calcification and calcium scores were determined for each patient, and the paired-t test was used to analyse the data. Results: The mean age of patients was 49.52 ± 8.83 years. Of these 60 women, 50% were postmenopausal and 50% were not. In 37 (61.7%) cases, mild to severe coronary calcification was observed, and 50 (83.3%) had mild to severe breast arterial calcification. There was a significant correlation between coronary calcification and breast artery calcification (p = 0.001), and there was also a significant relationship between coronary calcification and postmenopausal calcification (p < 0.001). Conclusions: Breast artery calcification can be a suitable predictor for coronary artery calcification and is a valid method for predicting cardiovascular disease probability in the future

Cachexia index and its relationship with resection operability in patients with gastric adenocarcinoma

Introduction: Gastric cancer is one of the relatively common malignancies all over the world, and is one of major problems of health care system. Nowadays, importance of cachexia is demonstrated in prognosis of various malignancies. The aim of the present study was to evaluate frequency of cachexia index and its relationship with resection operability in patients with gastric adenocarcinoma. Methods: In a descriptive-analytical study, 36 patients with gastric adenocarcinoma who referred to Imam Reza and Sina educational medical centers of Tabriz University of Medical Sciences, Tabriz, Iran, for surgery procedures, were included and evaluated in the study. Skeletal muscle index (SMI) was calculated using computed tomography (CT)-scan before performing surgery, patients’ cachexia index was calculated by the following formula: . Cachexia syndrome, patients’ weight loss, resection operability, and cachexia index were evaluated in patients. Results: Among 36 patients whom were studied, 25 patients (69.4%) were men, and 11 patients (30.6%) were women. Cachexia was seen in 5 patients (13.9%). In terms of gastrostomy operability, 26 patients (72.2%) were operable, and 10 patients (27.8%) were non-operable. Gastrostomy operability in patients with cachexia were significantly less than patients without cachexia syndrome (P = 0.001). No significant differences were seen in cachexia index of operable and non-operable patients (P = 0.105). Conclusion: Based on the findings of the present study, gastrostomy operability in patients with cachexia was significantly less than patients without cachexia syndrome; but operable and non-operable patients do not have significant differences in cachexia in comparison to each other

Determination of the Predictive Value of Serum Bilirubin in Patients with Ischemic Stroke: A Prospective Descriptive Analytical Study

Purpose: In all types of ischemic stroke, especially in the acute phase, excessive oxidative stress causes structural and functional damage to the brain. This may play a major role in the pathophysiology of the brain damage. Higher serum levels of bilirubin have therapeutic effects in oxidative stress-induced stroke. Nevertheless, role of increased serum levels of bilirubin in the acute phase of ischemic stroke is controversial. Methods: This study was a cross-sectional prospective descriptive study conducted in the Emergency Department (ED) of Imam Reza hospital, Tabriz University of Medical Sciences, Tabriz, Iran, throughout six months. 275 ischemic stroke patients were evaluated based on their brain CT scan infarct size, NIHSS, MRS, and serum levels of bilirubin. Later, data were analyzed using SPSS software. Results: Total, direct and indirect bilirubin levels were significantly higher in expired patients (p< 0.0001). Total (p< 0.0001), direct (p< 0.0001) and indirect (p< 0.0001) bilirubin levels, NIHSS score (p< 0.0001), and ischemic area (p< 0.0001) significantly predicted the outcome in these patients. Conclusion: Total, direct and indirect bilirubin levels was significantly associated with mortality in the acute phase of ischemic stroke patients

Total Pulmonary Artery Atresia Associated with Abnormal Pulmonary Venous Drainage as a Rare Presentation of Scimitar Syndrome

Scimitar syndrome or pulmonary venolobar syndrome is a rare, complex, and variable malformation of the right lung characterized by an abnormal right sided pulmonary drainage into the inferior vena cava, malformation of the right lung, abnormal arterial supply, and sometimes cardiac malformation. Despite the varying degrees of pulmonary hypoplasia and pulmonary artery hypertension, about half of the patients with scimitar syndrome are asymptomatic or mildly symptomatic when the diagnosis is made. Neonates have severe symptoms and worse prognosis while older children come to light because of recurrent respiratory infections, heart murmur, or an abnormal chest radiograph

Skuteczność diagnostyczna wskaźnika uwapnienia w ocenie istotnego zwężenia tętnic wieńcowych

Background: Coronary artery calcium score (CCS) is a quantitative assessment of calcifications detectable by multidetector computed tomography (MDCT). Aim: To evaluate diagnostic accuracy of CCS to detect significant stenosis in coronary arteries in symptomatic patients. Methods: The study population included consecutive symptomatic patients with suspected coronary artery disease (CAD) who were referred for coronary angiography. The group included 158 patients (64.6% males) who were all evaluated by unenhanced 64-slice computed tomography where calcium was quantified according to the Agatston method. The ROC curves were constructed to evaluate the discriminating power of the total CCS and CCS for each individual coronary artery in predicting the presence of significant stenosis. Results: The prevalence of significant CAD strongly increased with higher CCS. The area under the curve (AUC) for total CCS for diagnosing significant stenosis (&#8805; 50%) in at least one coronary artery was 0.83 (95% CI 0.74-0.92). Using the cut-off value of CCS &#8805; 7.7 at least one significant coronary stenosis was detected with the sensitivity and specificity of 86% and 71%, respectively. Significant coronary artery stenosis was better predicted by measuring CCS for individual coronary arteries than total CCS. The AUC of CCS for significant stenosis of each coronary artery was 0.80 for the right coronary artery (RCA), 0.72 for the left main (LM), 0.73 for the left anterior descending (LAD) and 0.76 for the left circumflex arteries (LCX). The optimal cut-off point was estimated for CCS of each coronary artery. It was set at &#8805; 3.1 for RCA, &#8805; 7.7 for LM, &#8805; 9.5 for LAD and &#8805; 4.5 for LCX. Positive and negative predictive values for an intact artery using a CCS of zero were 92.8% and 83.8%, respectively. Diagnostic performance of CCS for predicting stenosis of LM and LCX arteries was better in patients over age 65 than in younger patients. Conclusions: Coronary artery calcium score is useful in predicting coronary artery stenosis, especially in subjects in whom invasive diagnostic or therapeutic utilities seem to be used untimely. The current study suggests an optimal cut-off value of total CCS &#8805; 7.7 for detecting significant stenosis, and underlines the better predictive value for CCS of individual arteries.Wstęp: Wskaźnik uwapnienia tętnic wieńcowych (CCS) jest metodą ilościowej oceny zwapnień wykrywalnych w wielorzędowej tomografii komputerowej (MDCT). Cel: Ocena trafności diagnostycznej CCS w wykrywaniu istotnego zwężenia tętnic wieńcowych u pacjentów z objawami klinicznymi. Metody: Badana populacja obejmowała kolejnych pacjentów z objawami klinicznymi, z podejrzeniem choroby wieńcowej (CAD), kierowanych na angiografię. Grupa liczyła 158 pacjentów (64,6% mężczyzn), u których wykonano 64-rzędową tomografię komputerową z ilościową oceną uwapnienia wg metody Agatstona. Wykreślono krzywe ROC w celu oceny mocy dyskryminującej CCS całkowitego oraz CCS dla poszczególnych tętnic wieńcowych pod kątem wykrywania obecności istotnego zwężenia. Wyniki: Częstość istotnej CAD znacznie wzrastała wraz ze wzrostem CCS. Pole pod krzywą (AUC) dla CCS całkowitego w rozpoznawaniu istotnego zwężenia (&#8805; 50%) w co najmniej jednej tętnicy wieńcowej wyniosło 0,83 (95% CI 0,74-0,92). Przy użyciu wartości progowej CCS &#8805; 7,7 możliwe było wykrycie zwężenia tętnic wieńcowych z czułością i swoistością na poziomie odpowiednio 86% i 71%. Rozpoznawanie istotnego zwężenia przy użyciu CCS dla poszczególnych tętnic wieńcowych było skuteczniejsze niż przy użyciu CCS całkowitego. Pole pod krzywą CCS dla istotnego zwężenia poszczególnych tętnic wynosiło 0,80 dla prawej tętnicy wieńcowej (RCA), 0,72 dla pnia lewej tętnicy wieńcowej (LM), 0,73 dla tętnicy wieńcowej przedniej zstępującej (LAD) i 0,76 dla tętnicy okalającej (LCX). Optymalne wartości progowe określone zostały dla CCS każdej tętnicy wieńcowej: &#8805; 3,1 dla RCA, &#8805; 7,7 dla LM, &#8805; 9,5 dla LAD oraz &#8805; 4,5 dla LCX. Pozytywne i negatywne wartości stwierdzenia obecności tętnicy niezmienionej patologicznie przy CCS równym zero wyniosły odpowiednio 92,8% i 83,8%. Skuteczność diagnostyczna CCS w rozpoznawaniu zwężenia LM i LCX była wyższa u pacjentów w wieku powyżej 65 lat. Wnioski: Wskaźnik uwapnienia tętnic wieńcowych jest użyteczny w rozpoznawaniu zwężenia tętnic wieńcowych, szczególnie u pacjentów, u których diagnostyka lub leczenie inwazyjne mogą być ryzykowne. Niniejsze badanie sugeruje stosowanie optymalnej wartości progowej CCS całkowitego &#8805; 7,7 do wykrywania istotnych zwężeń, jak również zwraca uwagę na większą wartość diagnostyczną CCS dla poszczególnych tętnic

Predictive value of osteoprotegerin for detecting coronary artery calcification in symptomatic patients: correlation with extent of calcification detected by multidetector computed tomography

Introduction: Osteoprotegerin (OPG) could be a marker of vascular calcification extent. The purpose of this study was to evaluate relationships between OPG and coronary artery calcification (CAC) extent in an Iranian population. Methods: A total of 151 patients with chest pain [107 males/44 females, mean age: 57.23 (30-85)] were enrolled, excluding patients with previously established coronary artery diseases. All underwent chest multidetector computed tomography (MDCT) for CAC scoring. Blood samples were collected for measurement of OPG. A potential relationship between CAC, OPG, age and number of involved coronary arteries was investigated, and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of OPG that best predicted the presence of CAC. Results: A total of 93 patients did not have CAC, who were younger than others. The mean age of patients with a different number of involved arteries was significantly different and is significantly correlated with a number of involved coronary arteries. The mean level of OPG differed by the number of calcified coronary arteries and is significantly correlated with the number of involved coronary arteries. The level of OPG had a weak but positive correlation with Ca score. ROC curve analysis showed that plasma OPG level had a fair prediction of CAC score, with an area under ROC curve of 0.62. The cut-off value best predicting CAC score was 59.1 pg/ml. Conclusion: This study suggests that a serum level of OPG can fairly predict extent of coronary retry calcification in symptomatic population

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

Abstract Background Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). Case presentation The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. Conclusion In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method

Diagnostic Accuracy of a 64-Slice Multi-Detector CT Scan in the Preoperative Evaluation of Periampullary Neoplasms

Periampullary tumors are highly malignant masses with poor prognosis. Surgical resection is the only treatment for patients with this disease. The preoperative evaluation of masses is essential to determine the tumor resectability and vascular invasion. The aim of this study was to determine the diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) in detecting the resectability of periampullary masses. A cross-sectional study was conducted on patients with a definite diagnosis of periampullary cancer. All the participants underwent an MDCT scan before the surgical pancreaticoduodenectomy. The preoperative results were compared to the intraoperative findings and the diagnostic accuracy was determined based on the sensitivity and specificity of the MDCT. From June 2015 until June 2016, 32 patients with periampullary carcinoma were enrolled in the study. Of 32 masses, one of them considered nonresectable because of the gross vascular invasion in th CT images. After the operation, the overall resectability rate was 81.3%. The sensitivity and specificity of MDCT for tumor resectability was 100% and 16.7%, respectively, with an overall accuracy of 84.4%. To sum up, MDCT had high sensitivity but low specificity in the preoperative evaluation of preampullary carcinomas. The low specificity resulted from the low accuracy of the CT scan in detecting vascular involvement

Computed tomography imaging findings in hospitalized patients with coronavirus disease 2019 (COVID-19) : a descriptive study of 81 cases

Purpose: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has proven to be a diagnostic challenge. Early studies have shown that computed tomography (CT) imaging may be useful in diagnosis of these patients. We aim to report CT findings in a series of hospitalized patients. Material and methods: A total of 81 patients were included in this study. All of the patients were hospitalized and had SARS-CoV-2 infection proven by molecular assay. All patients had a CT scan on the first day of admission. Imaging results were reviewed by two separate radiologists, and imaging findings were documented. Results: Seventy-eight patients had abnormal CT imaging, while 3 had normal CT imaging. The sensitivity of CT in diagnosing coronavirus disease 2019 (COVID‑19) was estimated to be 96%. The most common imaging finding was ground glass opacities, followed by septal thickening. Most lesions were located at the periphery and posterior of the lungs. Most lesions were multifocal, and involved the right lower lobe more frequently. Chest X-rays were normal in 38 patients, and the sensitivity of chest X-ray in diagnosing SARS-Cov-2 was 54%. Conclusions: CT scans could be used in diagnosis of patients with a high sensitivity (93%). No commo