Long-term vitamin-K antagonist use and coronary artery calcification.

BACKGROUND: The aim of this study was to investigate the impact of vitamin K antagonist (VKA) therapy on coronary artery calcification (CAC) by comparing long-term VKA users with metallic prosthetic valves (MPVs) and VKA-free patients undergoing coronary calcium scoring for cardiovascular (CV) risk stratification. METHODS: A total of 108 patients (43 VKA users with MPV and 65 gender-, age-, and risk-factor-matched VKA-free patients) were included in the study. CAC was determined via computed tomography (CT) and quantified on the basis of the Agatston score. The VKA group comprised patients who had an MPV for longer than 5 years, which entailed long-term VKA use. RESULTS: Long-term VKA users had more calcified coronary arteries compared with the control group (178.1 ± 278 vs. 61.1 ± 130.6, p = 0.01). There was no difference between groups in terms of traditional CV risk factors. The mean duration of VKA use was 15 ± 7 years for the patients with MPV. There was no correlation between the duration of VKA use and mean Agatston score (r = 0.2, p = 0.215). CONCLUSION: With its unique selection of patient groups, our study extends the findings of previous research that long-term VKA use is related to CAC as detected via CT scanning. The longer and more potent VKA regimen required for MPV patients is the primary cause of CAC in this group.

Efficacy of amitraz plus inactivated parapoxvirus ovis in the treatment of canine generalised demodicosis.

Canine generalised demodicosis (CGD) is a challenging disease to treat effectively. Inactivated parapoxvirus ovis (iPPVO) could help to accelerate treatment with acaricidial therapy by altering the immune response. This study was designed to investigate the effects of treating CGD with amitraz plus iPPVO in terms of clinical outcomes and blood parameters. The study involved 16 dogs ranging in age from eight months to six years and weighing between 10 and 40 kg. Eight dogs were treated with amitraz and eight with amitraz plus iPPVO. Biochemical analysis of whole blood and serum, including serum C reactive protein (CRP) and serum amyloid A (SAA), was performed. Skin scrapings were conducted on days 0, 10, 40, 80 and 120 of treatment, and mite numbers were recorded. Clinical remission was determined according to mite numbers and clinical scores. The difference in mean whole remission days between the amitraz group (104.3 days) and the amitraz+iPPVO group (84.5 days) was statistically significant (P<0.05). Mean clinical scores were also significantly better in the amitraz+iPPVO (5.60) group when compared with the amitraz group (7.65). No adverse reactions were observed in either group. In view of these findings, the use of iPPVO in conjunction with amitraz can be recommended for treating CGD.

Correlation between hippocampal volume and excessive daytime sleepiness in obstructive sleep apnea syndrome.

BACKGROUND/AIM: The limbic system, specifically the hippocampus, plays a key role in controlling the sleep-wake cycle. Changes in these particular structures of the central nervous system have been suggested to be related to obstructive sleep apnea syndrome (OSAS). We hypothesized that reduced hippocampal volume is a risk factor for excessive daytime sleepiness (EDS) in OSAS. PATIENTS AND METHODS: Twenty-two patients with newly diagnosed OSAS and 20 healthy controls were included in the present study. Polysomnography was performed for each participant to determine the presence of OSAS. EDS was defined based on the Epworth sleepiness scale (ESS) score, and patients were grouped as sleepy or non-sleepy according to this score. The hippocampal volume was calculated by MR volumetry using a manual tracing technique. RESULTS: There was no significant difference between groups in demographic variables. The hippocampus was markedly smaller in the OSAS groups than in controls (p < 0.001 Hippocampal volume was negatively correlated with the ESS score (r = -0.631, p = 0.002). CONCLUSIONS: Our findings suggest that EDS is associated with reduced hippocampal volume in OSAS.

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy.

OBJECTIVE: To evaluate the diagnostic efficacy of thin-slice (1 mm) axial proton density-weighted (PDW) MRI of the knee for meniscal tear detection and classification. METHODS: We prospectively assessed pre-operative MR images of 58 patients (41 males, 17 females; age range 18-62 years) with arthroscopically confirmed meniscal tear. First, we evaluated the performance of the sagittal and thin-slice axial MR images for the diagnosis of meniscal tears. Second, we compared the correlation of tear types presumed from sagittal and axial MRI with arthroscopy and tear classification from axial MRI. Tears were classified on the sagittal plane and the axial plane separately. The diagnostic performance and tear classification were compared statistically with arthroscopy results, which is accepted as the standard of reference. RESULTS: 8 of 58 patients were removed from the study group because they had complex or degenerative tears. A total of 62 tears were detected with arthroscopy in 50 patients. On the sagittal images, sensitivity and specificity values were 90.62% and 70.37%, respectively, for medial meniscus tears and 72.73% and 77.14%, respectively, for lateral meniscus tears. The corresponding values for axial images were 97.30% and 84.00%, respectively, for medial meniscus tears and 95.65% and 80.50%, respectively, for lateral meniscus tears. There was no significant difference in tear classification between the arthroscopy results and the thin-slice axial PDW MRI results (p>0.05). CONCLUSION: thin-slice axial PDW MRI increases the sensitivity and specificity of meniscal tear detection and especially classification, which is important for surgical procedure decisions.

Solitary metastases and high-grade gliomas: radiological differentiation by morphometric analysis and perfusion-weighted MRI.

AIM: To evaluate the value of morphometric analysis and perfusion-weighted magnetic resonance imaging (MRI) in differentiating solitary metastases from high-grade gliomas. MATERIALS AND METHODS: Forty-eight tumours (22 high-grade gliomas and 26 solitary hemispheric metastases) were evaluated using conventional and perfusion-weighted MRI. T2-weighted, gradient-echo, echo-planar sequences were used for perfusion-weighted MRI. Relative cerebral blood volume (rCBV) ratios were calculated by dividing the rCBV of the intratumoural and peritumoural areas with the average CBV value of the normal white matter areas. Morphometric analysis was carried out by proportioning the area of peritumoural oedema to the mass area. Mann-Whitney U test and ROC curve analysis were applied for statistical analysis. P<0.05 was accepted as statistically significant. RESULTS: Mean rCBV ratios of intratumoural areas of high-grade gliomas and metastases were 5.02+/-2.47 and 4.62+/-2.46, respectively. No statistically significant difference was found (p=0.515). rCBV ratios of peritumoural oedema were 0.89+/-0.51 in high-grade gliomas and 0.31+/-0.12 in metastases. The difference was statistically significant (p<0.001). According to the results of morphometric analysis, a statistically significant difference was present between the two tumour types (p<0.001). CONCLUSION: Measuring the oedema: mass and rCBV ratios of the oedema surrounding the tumour prior to operation in solitary masses proved to be useful for differentiating metastases from high-grade gliomas.

The contribution of 3D-CISS and contrast-enhanced MR cisternography in detecting cerebrospinal fluid leak in patients with rhinorrhoea.

The aim of this prospective study was to evaluate the value of unenhanced (three-dimensional constructive interference in steady state (3D-CISS)) and contrast-enhanced MR cisternography (CE-MRC) in detecting the localisation of cerebrospinal fluid (CSF) leak in patients with rhinorrhoea. 17 patients with active or suspected CSF rhinorrhoea were included in the study. 3D-CISS sequences in coronal and sagittal planes and fat-suppressed T1-weighted spin-echo sequences in three planes before and after intrathecal contrast media administration were obtained. Images were obtained of the cribriform plate and sphenoid sinus. In addition, high-resolution CT (HRCT) was performed in order to evaluate the bony elements. The leak was present in 9/17 patients with 3D-CISS and 10/17 patients with CE-MRC. The leak from the cribriform plate to the nasal cavity in six patients and from the sphenoid sinus in four patients was nicely shown by CE-MRC. Eight of those patients were surgically treated, but spontaneous regression of the symptoms in two precluded any intervention. The leak localisations shown with CE-MRC were fully compatible with surgical results. The sensitivities of HRCT, 3D-CISS and CE-MRC for showing CSF leakage were 88%, 76% and 100%, respectively. In conclusion, 3D-CISS is a non-invasive and reliable technique, and should be the first-choice method to localise CSF leak. CE-MRC is helpful in conditions when there is no leak or in complicated cases with a positive beta2-transferrin measurement.

Myxoid neurofibromas of the breast: mammographical, sonographical and MRI appearances.

Neurofibromas arise from elements in the peripheral nervous system and are rarely detected in the breast. Neurofibromatosis is a phakomatosis that displays a wide spectrum of clinical expression with neurocutaneous abnormalities and involvement of multiple organ systems. Neurofibromas are more common in neurofibromatosis Type 1. They can show variable amounts of myxoid change, which affect their radiological findings. In this paper, we present a patient with neurofibromatosis Type 1 with mammographical, sonographical and MRI findings of myxoid neurofibromas in her left breast.

Eosinophilic mastitis.

In this report a case with eosinophilic mastitis is described. The non specific radiologic findings of eosinophilic mastitis are illustrated. Diagnosis was established by histopathological exam of needle biopsy material. Knowledge of this rare entity may be helpful in diagnosis and clinical management.

Transient splenial lesion of corpus callosum associated with antiepileptic drug: conventional and diffusion-weighted magnetic resonance images.

Transient focal lesions of splenium of corpus callosum can be seen as a component of many central nervous system diseases, including antiepileptic drug toxicity. The conventional magnetic resonance (MR) findings of the disease are characteristic and include ovoid lesions with high signal intensity at T2-weighted MRI. Limited information exists about the diffusion-weighted MRI characteristics of these lesions vanishing completely after a period of time. We examined the conventional, FLAIR, and diffusion-weighted MR images of a patient complaining of depressive mood and anxiety disorder after 1 year receiving antiepileptic medication.