Association of dipping pattern of blood pressure and atherosclerotic burden of coronary arteries in hypertensive patients.

Aim    The aim of this study was to determine the association between the dipping pattern of BP and coronary artery disease in hypertensive patients.Material and methods    A total of 356 hypertensive patients were included in the study. The results of ambulatory BP monitoring, echocardiography, and coronary computerised tomographic angiography were evaluated retrospectively. The patients were divided into two groups on the basis of their ambulatory BP monitoring: 1) patients with the dipping pattern of BP; 2) patients with the non-dipping pattern (NDP).Results    Among the 356 patients, 145 were male (40.7 %). The smoking status was higher in patients with NDP (p=0.023). The statin usage in patients with the dipping pattern was higher in patients with NDP (p=0.027). There were no significant differences in the echocardiographic findings. 58.6 % of the patients without plaque formation had the dipping pattern of BP (p<0.05), however 84.4 % of patients with >50 % plaque formation had the NDP of BP (p<0.001).Conclusion    The NDP of BP might be related to the increased atherosclerotic process in coronary arteries, and pa-tients with NDP might have an increased atherosclerotic burden for coronary arteries when compared with patients with a dipping pattern.

Prevalence of renal vascular variations: Evaluation with MDCT angiography.

PURPOSE: The purpose of this retrospective study was to investigate the prevalence of renal artery (RA) and renal vein (RV) variations, the distribution of these variations with respect to gender and the types of RA and RV variations on multi-detector computed tomographic (MDCT) angiography. MATERIALS AND METHODS: The MDCT angiography examinations of 504 patients (317 men, 187 women) with a mean age of 56.4 years±11.7 (SD) (range: 18-92 years) were retrospectively reviewed to determine the number and branching pattern of the RAs and the number and variations of the RVs (retroaortic or circumaortic left RV, late venous confluence). RESULTS: The prevalence of multiple RAs was 31.3% (22.2% for two RAs, 7.5% for three RAs, 1.4% for four RAs, 0.2% for five RAs) and prehilar branching was 6.5%. The prevalence of multiple right RVs was 21.6% (19.2% for two RVs, 2.2% for three RVs and, 0.2% for four RVs). The prevalence of circumaortic left RV was 5.2%, retroaortic left RV was 4.2% and, late venous confluence was 7.3%. No associations were found between gender and presence of RA or RV variations (P=0.630 and 0.650, respectively). CONCLUSION: Accessory RAs are frequently observed. Multiple right RVs is the most common RV variation. No associations are found between gender and RA or RV variations.

Imaging of acute pancreatitis and its complications. Part 2: complications of acute pancreatitis.

The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.

Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis.

Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

Sclerostin as a new key player in arteriovenous fistula calcification.

BACKGROUND: The osteocyte-derived sclerostin has been shown to play a key inhibitor role in determining the normal extent of bone formation, and it consequently protects against the deleterious effects of uncontrolled bone growth. Sclerostin has been demonstrated to be upregulated during vascular smooth muscle cell calcification in vitro and has recently been identified in the human aorta at the protein level. Whether the effects of sclerostin on bone turnover and its vascular expression also translate into clinically significant changes in arteriovenous fistula patency is unknown. PATIENTS AND METHODS: The primary outcome was loss of unassisted arteriovenous fistula patency, defined as arteriovenous fistula thrombosis or need for intervention. In this prospective cohort study, 350 prevalent hemodialysis patients were followed up for 12 months. Serum sclerostin levels were measured and arteriovenous fistula calcification was detected using a 64-detector computerized tomographic scanner. RESULTS: Patients with calcified arteriovenous fistula had higher serum sclerostin levels than patients without. Overall, 26 % of the patients reached the outcome during the follow-up. The 12-month arteriovenous fistula survival was reduced in patients with calcified arteriovenous fistulas. Patients with serum sclerostin levels above median levels at the start of the observation period had a worse arteriovenous fistula survival. Multivariable-adjusted Cox regression analyses revealed that only presence of arteriovenous fistula calcification and serum C-reactive protein level independently predicted loss of unassisted arteriovenous fistula patency. CONCLUSION: Our study suggests that the detection of arteriovenous fistula calcification and serum C-reactive protein levels might be useful for identifying patients at an increased risk for loss of unassisted arteriovenous fistula patency.

Intracavitary cardiac hydatid cysts with a high risk of thromboemboli. Invasive nature of cardiac echinococcosis.

Hydatid cysts are a serious health problem in many countries that raise farm animals, and they usually involve the liver and lungs. Although cardiac involvement is a rare manifestation of hydatid cyst disease, its early diagnosis and surgical management are crucial. Patients with cardiac hydatidosis may develop acute life-threatening complications secondary to their invasion of surrounding cardiac structures, such as cyst rupture together with systemic and pulmonary dissemination. Therefore, surgical excision is the definitive method of treatment for cardiac hydatid cysts in order to prevent these potential life-threatening complications, even for asymptomatic patients. Herein, we report the case of a 36-year-old man who initially presented with pleuritic chest pain, hemoptysis, and dyspnea. This was followed by the revelation of multiple cardiopericardial hydatid cysts which were discovered via transesophageal echocardiography and multislice computed tomography. In this case, there was a higher risk of cyst rupture and thromboembolism during systemic and pulmonary circulation due to the invasive nature of the cysts which were located in the left atrium as well as between the pulmonary artery and aorta. The patient successfully underwent the removal of the multiple cardiac cysts under cardiopulmonary bypass by taking into account their relationship with the surrounding cardiac structures and the potential risk of local, systemic, and pulmonary dissemination. A pathological evaluation of the surgical specimens confirmed the diagnosis of cardiac echinococcosis and the aggressive nature of the cardiopericardial hydatid cysts by demonstrating their myocardial invasion.

Left cervical aortic arch in conjunction with a complex arch aneurysm and subaortic left innominate vein.

We present a patient with left cervical aortic arch who had a complex aortic arch aneurysm consisting of multiple saccular aneurysmatic excavations, proximal aortic arch narrowing, a right subclavian artery aneurysm and subaortic left innominate vein diagnosed by computed tomographic angiography.

Clinical value of 16-slice multidetector computed tomography in symptomatic patients with suspected coronary artery disease.

BACKGROUND: Multidetector computed tomography angiography has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease. PURPOSE: To investigate the diagnostic accuracy and limitations of multidetector computed tomography (MDCT) in the detection of significantly (> 50%) obstructive coronary artery disease (CAD) using a scanner equipped with 16 x 0.625-mm collimation. MATERIAL AND METHODS: MDCT angiography was performed in 153 patients (99 male, 54 female; mean age 55 +/- 10 years) with suspected CAD and scheduled for conventional coronary angiography (CCA). Image quality was assessed in terms of artifacts and segment visibility, and the assessable segments were screened for the presence of significant stenoses (> 50% lumen diameter reduction). The diagnostic performance of MDCT for the detection of significant stenosis was compared with the results of CCA. RESULTS: In all 153 patients, MDCT was carried out without complications. A total of 1989 coronary artery segments were evaluated. After exclusion of 394 non-evaluable segments (19.8%), 1595 segments (80.2%) were included in the analysis. The most frequent causes of poorly assessable segments were motion artifact (36%) and severe calcification (23%). Considering only the segments judged to be evaluable, the sensitivity, specificity, and positive and negative predictive values of 16-slice MDCT were 85%, 97%, 79%, and 98%, respectively. Including all segments in the analysis (evaluable and non-evaluable), the sensitivity was 74%, specificity 96%, positive predictive value 73%, and negative predictive value 97%. CONCLUSION: When all coronary artery segments are included, 16-slice MDCT has moderate sensitivity and very high specificity and negative predictive value in assessing coronary artery stenoses. High specificity and negative predictive value indicate that 16-slice MDCT may be a useful tool in reliably ruling out significant lesions in patients with a low pretest probability.