Intratumoral Haemorrhage Causing an Unusual Clinical Presentation of a Vestibular Schwannoma.

We present a case of an elderly woman with no history of audiological disease with sudden onset of visual and hearing deficits associated with systemic clinical signs. On examination she had impairment of right CNs from V to X. CT and MR imaging demonstrated a cystic vestibu- lar schwannoma with a rare intralesional fluid-fluid level correlated to a recent bleed. We include high quality MR images to show the acute impairment of the cranial nerves next to the tumour after acute bleeding. Our case report includes a voxel-based morphometry (VMB) analysis of the tumour that, as far as we know, has never been done before for such a tumour. VBM analysis was performed to calculate the hypothesized volume changes after the acute bleed which likely resulted in a sudden increase in the overall size of the tumour resulting in atypical clinical signs and symptoms due to the establishment of a mechanical conflict with the adjacent cranial nerves

Nasal anomalies review with CT or MRI: from congenital to malignant.

Learning Objectives. To describe imaging findings of a wide spectrum of uncommon nasal cavity masses evaluated at our institution by CT, CBCT and MR imaging, clinically and pathologically proven. Background. In this work we present a succinct review of disease illustrated by a retrospective case series of nasalcavity masses, evaluated at our institution. between 2010 and 2013. Patients have been studied with different imaging modalities including multiraw computed tomography (CT), cone beam computed tomography (CBCT) and magnetic resonance imaging (MR) to illustrate the findings and to summarize the main diagnostic keypoints for the differential diagnosis of nasal masses. Clinicopathological correlation is also reported and imaging findings we present have been isthopathologically proven. Images aid in recognition and characterization of the lesions. Many different types of lesions may involve the nasal cavities and imaging studies, CBCT, CT and MR, provide anatomical details and could be helpful first in differentiating benign to malignant lesions and secondary in characterization of the lesion. Referring to non neoplastic lesions, rinoliths, piogenic granuloma and septal mucocele are reported. Referring to benign and borderline tumors osteoma, hamartoma, hemangioma, hemangiopericytoma, cemento-ossifying fibroma, antrochoanal polip and inverted papilloma are reported. Referring to malignant neoplasms intestinal type adenocarcinoma, esthesioneuroblastoma and Non-Hodgkin lymphoma are reported. CONCLUSION. This review of uncommon nasal masses studied with different imaging modalities (CT, CBCT and MRI)should be useful in differential diagnosis of the wide spectrum of nasal tumors and non tumors masses

Coronary Microvascular Dysfunction Induced by Primary Hyperparathyroidism is Restored After Parathyroidectomy

Background— Symptomatic primary hyperparathyroidism (PHPT) is associated with increased cardiovascular mortality. However, data on the association between asymptomatic PHPT and cardiovascular risk are lacking. We assessed coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic PHPT of recent onset. Methods and Results— We studied 100 PHPT patients (80 women; age, 58±12 years) without cardiovascular disease and 50 control subjects matched for age and sex. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR was lower in PHPT patients than in control subjects (3.0±0.8 versus 3.8±0.7; P <0.0001) and was abnormal (≤2.5) in 27 patients (27%) compared with control subjects (4%; P =0.0008). CFR was inversely related to parathyroid hormone (PTH) levels ( r =−0.3, P <0.004). In patients with CFR ≤2.5, PTH was higher (26.4 pmol/L [quartiles 1 and 3, 16 and 37 pmol/L] versus 18 [13–25] pmol/L; P <0.007), whereas calcium levels were similar (2.9±0.1 versus 2.8±0.3 mmol/L; P =0.2). In multivariable linear regression analysis, PTH, age, and heart rate were the only factors associated with CFR ( P =0.04, P =0.01, and P =0.006, respectively). In multiple logistic regression analysis, only PTH increased the probability of CFR ≤2.5 ( P =0.03). In all PHPT patients with CFR ≤2.5, parathyroidectomy normalized CFR (3.3±0.7 versus 2.1±0.5; P <0.0001). Conclusions— PHPT patients have coronary microvascular dysfunction that is completely restored after parathyroidectomy. PTH independently correlates with the coronary microvascular impairment, suggesting a crucial role of the hormone in explaining the increased cardiovascular risk in PHPT

Long-term prognostic value of coronary flow reserve in psoriasis patients

BACKGROUND AND AIMS Psoriasis affects more than 3% of the general population and is associated with an increased risk of premature cardiovascular events and death. We assessed the prognostic role of coronary flow reserve (CFR) as a marker of coronary microvascular function in psoriasis patients asymptomatic for cardiovascular disease. METHODS We retrospectively analyzed 153 prospectively collected patients affected by psoriasis (123 male; age 36 ± 8 years) without cardiovascular disease. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR ≤2.5 was the cut off to define the presence of coronary microvascular dysfunction (CMD). RESULTS CMD was present in 23 patients (15%). Multivariable logistic regression analysis showed that CMD was associated with severe psoriasis (OR 3.1, p = 0.03), psoriatic arthritis (OR 2.9, p = 0.03), hypertension (OR 4.1, p = 0.009), and time elapsing since psoriasis diagnosis >6 years (OR 1.9, p = 0.03). Patients with CFR ≤2.5 had a lower survival free from events (p < 0.0001). CONCLUSIONS In psoriasis patients, CFR may be a reliable prognostic marker for cardiovascular event-free survival and may help identify patients at higher risk of developing cardiovascular complications. Whether novel biologic therapies able to reduce skin disease will improve CMD and prognosis in these patients needs to be further studied, prospectively

mirnas may change rapidly with thoughts the relaxation response after myocardial infarction

Abstract Introduction Mental stress is potentially a major cardiovascular risk factor. Meditation and listening to music may be able to compensate by eliciting the Relaxation Response (RR) with a beneficial prognostic impact after myocardial infarction (MI), reducing the progression of the arteriosclerotic process and improving coronary blood flow. We aimed to study a possible epigenetic mechanism of the RR speculating that circulating microRNAs levels could change during relaxation. Methods We enrolled 150 consecutive patients after MI. 50 were trained to meditate, 50 given music appreciation and 50 served as controls. In addition, in order to rule out that the disease state could interfere with the possible movement of microRNAs, we enrolled 50 healthy volunteers (25 were trained to meditate and 25 had music appreciation). After training, and after 60 days of RR practice, we studied the individual variation, before and after the relaxation session, of some important cardiovascular circulating microRNAs: the microRNA-1, −16, −24, −33, −92, −144, −146, −155. Results As the RR appeared to be triggered in the same way irrespective of whether this was by music or meditation data was combined. After the RR, a reduction in microRNA-16, −33, −92, −144, −146, −155 (p  Conclusions The RR modulates some microRNAs levels suggesting that psychic activity may be an important epigenetic and pathophysiological factor in the arteriosclerotic process and in ischemic heart disease. In particular, the analyzed microRNAs levels seems to vary in relation to the state of stress or relaxation of the subjects

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

IntroductionThe use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated. Aim of the studyWe aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH. Materials and methodsWe performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint. ResultsTwenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH. ConclusionProphylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option

Non-invasive Coronary Flow Velocity Reserve Assessment Predicts Adverse Outcome In Women With unstable angina Without Obstructive Coronary Artery Stenosis

Background: Evaluation of coronary flow velocity reserve (CFVR) is the physiological approach to assess the severity of coronary stenosis and microvascular dysfunction. Impaired CFVR occurs frequently in women with suspected or known coronary artery disease . The aim of this study was to assess the role of CFVR to predict long-term cardiovascular event rate in women with unstable angina (UA) without obstructive coronary artery stenosis. Methods: CFVR in left anterior descending coronary artery was assessed by adenosine transthoracic echocardiograhy in 161 women admitted at our Department with UA and without obstructive coronary artery disease. Results: During a mean FU of 32.5 ±19.6 months, 53 cardiac events occurred: 6 nonfatal acute myocardial infarction , 22 UA, 7 coronary revascularization by percutaneous transluminal coronary angioplasty, 1 coronary bypass surgery, 3 ischemic stroke and 8 episodes of congestive heart failure with preserved ejection fraction and 6 cardiac deaths. Using a ROC curve analysis, CFVR 2.14 was the best predictor of cardiac events and was considered as abnormal CFVR. Abnormal CFVR was associated with lower cardiac event-free survival (30% vs 80%, p&lt;0.0001). During FU, 70% of women with reduced CFVR had cardiac events whereas only 20% with normal CFVR (p=0.0001). At multivariate Cox analysis, smoke habitus (p=0.003), metabolic syndrome (p=0.01), and CFVR (p&lt;0.0001) were significantly associated with cardiac events at FU. Conclusion: Noninvasive CFVR provides an independent predictor of cardiovascular prognosis information in women with UA without obstructive coronary artery disease whereas, impaired CFVR seems to be associated with higher CV events at FU

STAFNE BONE CYST IN THE ANTERIOR MANDIBLE: AN UNUSUAL LOCATION

To describe clinical features of the anterior Stafne bone cyst. To supply radiologist a guide for diagnosis and classification of Stafne bone cyst

Coronary Collateral Circulation: A New Predictor of Mortality in Heart Transplant Recipients With Allograft Vasculopathy

Background: Coronary collateral arteries (CCAs) are anastomotic channels between vessels; although beneficial in atherosclerosis, their role in heart transplantation (HT) recipients is underinvestigated. CCAs initially develop as microcirculation and cardiac allograft vasculopathy (CAV), promoting immune-dependent proliferative angiogenic response, and play a role in their development. In our hypothesis, ischemia induced by coronary microvascular dysfunction (CMD) triggers the development of CCAs, which are, in turn, less functional as affected by CAV themselves. Methods: One hundred twenty-one patients receiving HT at our institution were retrospectively evaluated and were included if transthoracic echocardiography with coronary flow velocity reserve (CFVR) assessment and coronary angiography were performed. CMD was defined as CFVR of ≤2.5. Patients with CAV were enrolled, and their angiograms were reviewed to evaluate the presence of CCAs. Cardiovascular mortality was assessed as the main clinical outcome. Results: Forty patients were found to have CCAs. Patients with CCAs have lower CFVR than those without CCAs (2.22 ± 0.72 versus 2.69 ± 0.92;P = 0.003), reflecting in different rates of CMD in the 2 groups (72.5% versus 37%; P < 0.001). CMD is associated with higher CAV grades (P < 0.001), which are also associated with CCAs (P < 0.001). Patients with poorly developed CCAs have lower CFVR (P < 0.001). At multivariable analysis, CMD (P = 0.008) and higher CAV grades (P = 0.005) are independent predictors of CCAs. During the median follow-up time of 10.2 (6.6-13.3) y, patients with CCAs have been found to have higher mortality than those without CCAs (57.5% versus 32.1%; P = 0.007). CCAs are associated with a lower probability of survival also in patients with CMD (P < 0.001) and are independent predictors of mortality (P < 0.001). Conclusions: Our results demonstrate an interplay between CAV, CMD, and CCAs. We confirm that CAV is associated with CMD, and we show, for the first time, that CMD is associated with CCAs. CCAs are pathophysiologically associated with more severe graft vasculopathy and independently predict mortality after HT