Dilated Vessels Research Articles

Sonographic Detection of Iatrogenic Carotid Artery Guidewires During Internal Jugular Vein Catheterization

Background: Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. Methods: This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization. Using an inanimate model, investigators placed guidewires randomly into the carotid artery or IJ vein. Residents, blinded to guidewire location, scanned the model and recorded their findings. The test performance of POCUS for arterially placed guidewires was evaluated through calculation of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy, using investigator placement as the non-reference standard. Results: Twenty-five residents performed 51 observations. The test performance of POCUS for identifying arterially placed guidewires was sensitivity 95.0% (95%CI = 73.1-99.7%), specificity 96.8% (95%CI = 81.5-99.8%), NPV 96.8% (95%CI = 81.5-99.8%), and PPV 95.0% (95%CI = 73.1-99.7%). The overall accuracy was 96.1% (95%CI = 86.8-98.9%). Residents reported being very confident in their findings in 88.2% of all observations (95%CI = 76.6-94.5%), somewhat confident in 9.8% (95%CI = 4.3-21.0%), and not very confident in 2.0% (95%CI = 0.4-10.3%). No errors occurred among upper-level residents (post-graduate years 2-3) or those reporting >5 prior wire visualizations in live patients. Conclusions: This study is the first to demonstrate that physicians can easily identify misplaced guidewires located in the carotid artery with a high degree of accuracy using POCUS. We recommend routine scanning of the IJ vein and carotid artery prior to vessel dilation to reduce the likelihood of carotid artery injury.

Effectiveness of super-selective digital subtraction angiography and 3D rotational digital subtraction venography for a developmental venous anomaly with an arteriovenous malformation: A case report and literature review

Background: Arteriovenous malformation (AVM) and developmental venous anomaly (DVA) rarely coexist. Developing a surgical strategy to treat this co-occurrence is difficult due to the unclear pathogenesis. We report the use of super-selective digital subtraction angiography (DSA) and Three-dimensional (3D) rotational digital subtraction venography (DSV) to develop a surgical strategy for complex AVM draining into a DVA. Case Description: A 58-year-old woman presented with left hemiparesis and unconsciousness. Plain and contrast computed tomography showed a right frontal subcortical hematoma and a heterogeneous contrast lesion anterior to the hematoma, leading to a dilated vessel. The hematoma was removed due to worsening unconsciousness. DSA revealed a right frontal AVM of Spetzler-Martin grade 2 with superficial drainage into a DVA, and 3D-DSV revealed that the intermediate part of the DVA involved normal parenchyma. Interventional transarterial embolization and surgical nidus removal were planned. Preoperative super-selective DSA showed two medullary veins draining from the AVM into the DVA. Thus, we decided to separate the two medullary veins from the nidus. Postoperative angiography revealed complete removal of the AVM and preservation of the DVA. Conclusion: Treating a complex AVM draining into a DVA is challenging; surgeons have to remove only the AVM portion and preserve the DVA. Super-selective DSA and 3D rotational DSV were performed to develop the surgical strategy.

Viral Meningoencephalitis and Bilateral Blurry Vision.

A 20-year-old Chinese woman was experiencing fever, malaise, headache, nausea, vomiting, and neck stiffness for 2 weeks. Further examination revealed inflammation, vitritis and cystoid macular edema, tortuous dilatation of retinal venous vessels with fluorescence leakage, and hyperfluorescence in the optic disc. What would you do next?

Clinical Profiles of Retinal Vasoproliferative Tumors

Purpose: To describe the clinical features and treatment outcomes of patients with retinal vasoproliferative tumors. Methods: This retrospective case series comprised patients diagnosed with a retinal vasoproliferative tumor. Electronic medical records were reviewed, and patients’ demographic details, clinical presentation, and treatment outcomes were analyzed. Results: Nineteen eyes of 19 patients with vasoproliferative tumors were included. The mean age (±SD) at presentation was 37.0 ± 16.95 years. No eye had bilateral tumors, and 1 eye had multiple tumors. Three eyes (15%) had primary tumors, while 16 (84%) had secondary tumors. Primary tumors mainly affected the inferotemporal quadrant (n = 3). Secondary tumors involved the inferior quadrant (n = 4), inferotemporal quadrant (n = 5), and inferonasal quadrant (n = 5). Secondary tumors were associated with Coats disease (n = 6), intermediate uveitis (n = 3), traumatic chorioretinopathy (n = 2), familial exudative vitreoretinopathy (n = 2), retinal vasculitis (n = 2), and retinal vascular occlusion (n = 1). Retinochoroidal features included intraretinal and subretinal exudates, subretinal fluid, intraretinal hemorrhaging, vitreous hemorrhaging, cystoid macular edema, vitritis, preretinal fibrosis, dilated feeding vessel, epiretinal membranes, and tractional retinal detachment. Treatment modalities included cryotherapy, laser photocoagulation, and local steroids. The mean follow-up was 25.3 months, during which 18 eyes had tumor regression and 1 had a worsening condition. Conclusions: Secondary vasoproliferative tumors were more frequently observed than primary tumors, often presenting as unilateral, unifocal tumors situated posterior to the equator in the inferior fundus. Conventional treatment approaches, such as cryotherapy and laser photocoagulation, were effective at tumor regression and often required multiple sessions.

Limfatičke malformacije

Lymphatic malformations are abnormal cystic dilatations of lymphatic vessels. They are present at birth, but often can only be detected later in life. Simple lymphatic malformations are limited to certain anatomical regions, while complex diffuse abnormalities can affect the entire organism. Simple lymphatic malformations are divided into macrocystic (cysts >1cm) and microcystic (cysts <1cm). According to the ISSVA classification from 2015, the term lymphangioma is abandoned and the term lymphatic malformation is introduced, which is intended to clearly indicate that it is not a tumor formation. The clinical course is characterized by long asymptomatic periods with short-term inflammatory or infectious episodes and episodes of intracystic bleeding. In the case of voluminous changes, the diagnosis can be made at the transition from the second to the third trimester of pregnancy by ultrasound examination or fetal magnetic resonance. Ultrasound and magnetic resonance imaging are diagnostic methods of choice in the postpartum period as well. The purpose of the treatment is not to completely remove the formation, but to limit the symptoms to the extent that would preserve functionality and provide an appropriate appearance. Treatment methods are the expectant method for asymptomatic disease, sclerotherapy, surgical resection, drug treatment, laser treatment and physical therapy measures. When there is no life-threatening airway obstruction, sclerosing is the method of choice. Bleomycin as a sclerosant provides good results with mild side effects. Therapy with rapamycin (sirolimus) allows for a large percentage of reduction in formation, but it is important to monitor possible side effects

Effect of Sertraline and Vortioxetine on Stress-Induced Brain Injury in Rats: Biochemical and Histopathological Evaluations

Objectives Our aim was to evaluate the comparative effects of sertraline and vortioxetine against stress-induced brain injury in rats. Methods The rats were assigned to a nonstress group (NSG), stress-treated control (StC), sertraline + stress (SSt), and vortioxetine + stress (VSt) groups. Sertraline and vortioxetine (10 mg/kg) were given orally by gavage to the SSt and VSt groups. One hour later, all animals (except NSG) underwent forced immobilization to establish a stress model (2 hours). The drugs were given once a day for 30 days. The animals were killed with ketamine 150 mg/kg, and tissues were removed from the cerebral cortex. One-way analysis of variance and Fisher post hoc least significant difference were conducted for the analysis. Results The malondialdehyde (nmol/mL) level was 2.58 ± 0.48 in the NSG, 8.09 ± 0.57 in the StC, 3.84 ± 0.53 in the SSt, and 2.84 ± 0.20 in the VSt group (P < 0.0002). The total glutathione (mmol/g) was 7.15 ± 0.59 in the NSG, 2.41 ± 0.43 in the StC, 4.58 ± 0.26 in the SSt, and 5.98 ± 0.13 in the VSt (P < 0.0002). The total oxidant status (mmol H2O2Eq/L) level was 3.56 ± 0.20 in the NSG, 9.99 ± 0.74 in the StC, 4.97 ± 0.39 in the SSt, and 3.81 ± 0.31 in the VSt (P < 0.0002). The total antioxidant status (mmolTroloxEq/L) level was 8.65 ± 0.37 in the NSG, 3.04 ± 0.22 in the StC, 6.29 ± 0.34 in the SSt, and 7.61 ± 0.40 in the VSt (P < 0.0002). Sertraline reduced pericellular edema in astrocytes and oligodendrocytes and decreased perivascular edema, dilatation, and congestion of blood vessels, whereas these were not seen with vortioxetine. Conclusions Compared with sertraline, vortioxetine is a neuroprotective antidepressant with higher antioxidant activity and can more effectively prevent stress-induced brain tissue injury.

The Effect of Ginger Water Decoction on Leg Edema in Pregnant Mothers at Kasih Ibu Primary Clinic, 2024

The bending of the uterus restricts venous return and gravitational pull, which increases fluid retention and causes 80% of pregnant women in the third trimester to experience leg edema or swelling. Edema in pregnant women’s legs can be a sign of dangerous pregnancy conditions, such as pre-eclampsia. Edema is also very dangerous for pregnant women as it can lead to issues with the heart, kidneys, and other body parts, disrupting their functions. Foot soaking, or foot hydrotherapy, is an additional therapy that can be done independently. To improve blood circulation and trigger a systemic response (vasodilation) through the dilation of blood vessels, bathing with warm water will help. The authors aim to conduct research on "The Effect of Ginger Decoction on Edema in Pregnant Women's Legs at Kasih Ibu Pratama Clinic in 2024" based on the above information and data. They believe that foot soaks can also be combined with other herbal ingredients. The research method used a population of 100 with a sample of 17 individuals, employing a quantitative research design and a one-group pre-test post-test model, where observations were made before and after treatment with data analysis using the Wilcoxon test. The study found that ginger decoction has an effect on reducing edema in the legs of pregnant women. The test results showed a probability of 0.01. This means that the probability < level of significance (? = 0.05), so Ha is accepted, and H0 is rejected, indicating a significant difference between leg edema in pregnant women before (pre-test) and after (post-test) the administration of ginger decoction. Therefore, ginger decoction has an effect on reducing edema in pregnant women's legs.

Intramuscular hemangioma capillary type with HRAS mutation: Expanding the molecular genetic spectrum with an emphasis on overlap with arteriovenous malformations and distinct from infantile hemangioma

AimsIntramuscular hemangioma capillary type (IHCT) is a rare entity that refers to fast-flow vascular lesions. This study aims to elucidate the relationships between clinicopathological, radiological, and molecular characteristics in IHCT patients. Methods and resultsWe reviewed all IHCT cases which were treated surgically in our pathology database from 2014 to 2023. Ten cases were analyzed via next-generation sequencing (NGS) and Sanger sequencing. The cohort consisted of 10 patients (6 males, 4 females) with a median age of 18 years (range: 1–37). Disease lesions were located in the trunk (n = 4), upper extremity (n = 2), lower extremity (n = 2), shoulder (n = 1), and neck (n = 1). IHCT is most commonly a progressively increasing painless mass. Histopathologically, all lesions exhibited aggregates, lobules, and anastomosing cords of capillary-type vessels separating or infiltrating the skeletal muscles. Four cases exhibited irregularly dilated vessels with thick walls, such as arteriovenous malformations (AVM) in the lesion's periphery. MRI findings commonly demonstrated a well-delineated, homogeneous mass. Somatic mutations were detected in seven of the ten IHCT cases. Four cases harbored mutations in MAP2K1 (p.Q58_E62del, p.K57_G61del, p.K57 N), two cases harbored mutations in KRAS (p.Q61R and p.L56V, p.G13R), and one case harbored a mutation in HRAS (p.D69_Q70insRWYSAMRD). Mutant allele frequencies detected by sequencing ranged from 9.98% to 15.97%. ConclusionsThe hemodynamic and molecular genetic phenotypes of IHCT closely resemble those observed in AVMs. Newly identified KRAS missense mutations, including cases with coexisting mutation types, and HRAS insertion mutations offer valuable insights into the genetic basis of vascular anomalies. These findings may also present potential targets for the development of novel pharmacotherapeutic interventions.

Cervical angiofibroma of soft tissue: A rare case report with literature review.

Angiofibroma of soft tissue (AFST) is a rare benign fibrous tumor recently included in the 2020 WHO classification of soft tissue and bone tumors. Currently, there are limited reports on AFST, and pathologists lack sufficient understanding of its clinical and pathological characteristics. There is scarce literature available on AFST in the cervical region. We presented a case of a 49-year-old woman who was admitted to our hospital for emergency treatment due to vaginal bleeding and fatigue. Ultrasound revealed a 63 × 27 mm hypoechoic mass extending from the cervical opening to the external opening, with a hemoglobin level of 58.0 g/L on blood routine. The tissue exhibited a pale-yellow mucinous appearance with distinct tissue boundaries and a fibrous capsule under a microscope. HE staining revealed spindle-shaped fibroblast-like cells with a consistent morphology, thin-walled branching small blood vessels, and dilated blood vessels. Regions with abundant cells and areas with sparse cells were alternately distributed and migrated gradually. Immunohistochemical analysis indicated positive expression of P53, desmin, progesterone receptor, estrogen receptor, epithelial membrane antigen, vimentin, CD68, CD163 in the tumor, but negative expression of P16, S-100, smooth muscle actin, CD117, CD10, STAT-6. CD34 was negative in the tumor cells but positive in the vascular endothelium. The Ki-67 index value was 5%. Pathological examination confirmed a soft tissue angiofibroma of the cervix. Emergency hysteroscopic surgery was performed following infusion of 3 units of packed red blood cells. A local excision of the cervical mass was performed. A 1-month follow-up ultrasound showed no abnormal mass in the cervical canal, and there have been no signs of recurrence to date. Cervical angiofibroma of soft tissue is a rare tumor with a benign clinical manifestation, minimal local recurrence, and no significant metastatic potential. Treatment primarily involves local resection with a focus on achieving negative surgical margins. By presenting this case, we aim to enhance the diagnostic and differential diagnostic capabilities of pathologists in identifying uterine tumors and preventing misdiagnosis.

Solitary fibrous tumor of the stomach

Abstract Introduction/Objective Solitary fibrous tumor (SFT) is an uncommon fibroblastic tumor that originates from the mesenchymal tissue. It has been rarely reported within the stomach. None of these reported tumors have occurred in a background of autoimmune atrophic gastritis as was seen in our patient. Methods/Case Report Case report Results (if a Case Study enter NA) An 85-year-old female with history of anemia and autoimmune atrophic gastritis presented with two-month history of dysphagia and abdominal discomfort. Upper gastrointestinal endoscopy showed a 1 cm subepithelial lesion in the gastric body along the greater curvature. Upper endoscopic ultrasound showed mildly hypoechoic lesion in the submucosa of the stomach with the differential of leiomyoma, neuroendocrine tumor, gastrointestinal stromal tumor, and an atypical looking lipoma. The entire gastric lesion was lifted with submucosal saline injection and then resected using cap endoscopic mucosal resection (EMR) snare cautery. Gross examination showed a well-circumscribed lesion with firm, tan-white cut surface. On microscopy, a bland appearing spindle cell proliferation within a collagenous stroma was seen with alternating hypercellular and hypocellular areas and few dilated vessels. No significant mitosis, nuclear pleomorphism or necrosis was identified. Immunohistochemical stains were performed and the lesional cells were positive for STAT6. Markers for gastrointestinal stromal tumor (CD117, DOG1), smooth muscle tumor (desmin, smooth muscle actin) and schwannoma (S100, SOX10) were negative. Nuclear staining for STAT6 is a sensitive and specific marker for SFTs. This particular SFT was considered to be of low risk and non-malignant considering its small size, lack of mitotic activity and tumor necrosis. The etiology for SFT is not entirely clear but molecular studies have shown that the NAB2::STAT6 translocation in a spindle cell neoplasm is a diagnostic hallmark for SFTs. Conclusion Solitary fibrous tumors have been rarely reported within the stomach. Complete surgical resection with negative margins is the mainstay of treatment as they may recur after an incomplete resection.

Pigmented Purpuric Dermatoses in Children: A case Report & Importance of Clinicopathological Correlation

Abstract Introduction/Objective Pigmented purpuric dermatoses are characterized by chronic but benign cutaneous eruptions featuring petechiae, purpura, or yellow to brown patches. It is more common in adult males and adolescents is generally localized on the lower limbs and has been reported in children multiple times. Our objective is to bring to consideration that it is not very uncommon in children and clinicopathological correlation is very important for a confirmed diagnosis. Methods/Case Report In our study, we report a case of 9 years 9-year-old girl with asymptomatic brown patches on lower legs bilaterally but asymmetrically since > 6-8 months. Histopathology was suggestive of typical features suggestive of PPD, including dilated blood vessels, endothelial cell swelling, hemosiderin deposition, red cell extravasation, and perivascular lymphocytic-macrophage infiltration. Pediatric instances of PPD are infrequently documented, due to their exclusion from the other differential diagnosis of purpura, post-inflammatory hyperpigmentation, and atopic dermatitis in this age group. Because these conditions lack systemic findings and share similar clinical presentations with other skin disorders, they may be overlooked or mistaken for more common conditions in pediatric patients. Histopathology plays a vital role in case of patches of persistent pigmentation on the skin especially lower limbs to rule out PPD. In many cases of pediatric PPD, it is usually considered self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside, narrow-band ultraviolet B treatment, and topical corticosteroids. Results (if a Case Study enter NA) In many cases of pediatric Pigmented purpuric dermatosis is usually considered as self-resolving, but there is complete resolution has also been reported with Vitamin C, rutoside [3] narrow-band ultraviolet B treatment and topical corticosteroids. Conclusion Our study aims to emphasize improving diagnostic accuracy, especially in pediatric cases, enhancing outcomes, and understanding the necessity of histopathological diagnosis in pediatric PPD cases. We also seek to abate the risk of misdiagnosis or underdiagnosis, and the need for increased awareness of this diagnosis in pediatric cases so that we can counsel and manage patients and their families accordingly. Through a comprehensive review of existing literature, we advocate for the inclusion of Schamberg’s type purpura as a differential diagnosis for purpuric eruptions or cutaneous discoloration in childhood.

A Rare Case Report of Cervical Hemangiomatous Polyp.

The uterine cervix is a rare site for cavernous hemangiomas. Cervical hemangiomas are slow-growing tumors with characteristic histological findings, including dilated vessels with increased endothelial cells. Although their pathophysiology remains unclear, hormones are believed to play an important role in the development of these vascular tumors. They may be asymptomatic due to their small size, but they can cause gynecological and obstetrical complications, including abnormal uterine bleeding and impaired fertility. Due to their small size, conservative treatment is the first line of management. Hysterectomy is considered for refractory cases or for patients who are not of childbearing age. We present a case report of a 62-year-old postmenopausal female with postmenopausal bleeding and a polypoid mass hanging over the anterior cervical wall through its stalk. The surgical biopsy revealed no signs of neoplastic changes, with the only notable finding being a polypoidal lesion representing a cavernous hemangiomatous cervical polyp.

In ovo toxico-pathological effects of medicinal plants used against coccidiosis on chicken embryos development and hatchability

TOXICO-pathological effects of herbal plants have always been a major concern, but little information is provided on the toxico-pathological effects of medicinal plants used against coccidiosis. This study aimed to assess the histopathological effects of Carica papaya seeds (CPS), Azadirachta indica leaves (AIL), and Sarcocephalus latifolius root (SLR) used as coccidiostat in traditional poultry farms with various doses using the chick embryo model. A total of 420 Sasso breeder eggs at ED4 of incubation were inoculated with the extract of these plants following a 3×4 factorial design with 3 plant extracts (CPS, AIL and SLR) and 4 inoculation doses (0, 25, 50 and 100 mg/kg egg-weight). From ED6 to ED19, the weights of the albumen and embryo were recorded, and the weights of ED19 embryo organs such as liver, heart, kidney, and lungs were measured. Additionally, histopathological lesions were examined. The results indicated that the presence of various phytoconstituents such as alkaloids, phenolics, flavonoids, tannins, saponins, coumarins, steroids, and triterpenes with statistically significant free-radical-scavenging ability differed among the plant extracts (p < 0.0001). Toxico-pathological examination revealed a dose-dependent slight toxicity (p < 0.0001) of the Azadirachta indica leaves extract compared to the other plants. Additionally, the relative organ weight showed kidney hypertrophy (p = 0.001) and liver hypertrophy (p = 0.0001), as well as dilation of hepatic and cardiac vessels. The conclusion drawn was that chicken embryos are more susceptible to in ovo inoculation with Azadirachta indica leaves compared to Carica papaya seeds and Sarcocephalus latifolius root.

Spinster homolog 2 (SPNS2) deficiency drives endothelial cell senescence and vascular aging via promoting pyruvate metabolism mediated mitochondrial dysfunction

Endothelial cell (EC) senescence and vascular aging are important hallmarks of chronic metabolic diseases. An improved understanding of the precise regulation of EC senescence may provide novel therapeutic strategies for EC and vascular aging-related diseases. This study examined the potential functions of Spinster homolog 2 (SPNS2) in EC senescence and vascular aging. We discovered that the expression of SPNS2 was significantly lower in older adults, aged mice, hydrogen peroxide-induced EC senescence models and EC replicative senescence model, and was correlated with the expression of aging-related factors. in vivo experiments showed that the EC-specific knockout of SPNS2 markedly aggravated vascular aging by substantially, impairing vascular structure and function, as evidenced by the abnormal expression of aging factors, increased inflammation, reduced blood flow, pathological vessel dilation, and elevated collagen levels in a naturally aging mouse model. Moreover, RNA sequencing and molecular biology analyses revealed that the loss of SPNS2 in ECs increased cellular senescence biomarkers, aggravated the senescence-associated secretory phenotype (SASP), and inhibited cell proliferation. Mechanistically, silencing SPNS2 disrupts pyruvate metabolism homeostasis via pyruvate kinase M (PKM), resulting in mitochondrial dysfunction and EC senescence. Overall, SPNS2 expression and its functions in the mitochondria are crucial regulators of EC senescence and vascular aging.

Persistent Serous Choroidal and Retinal Detachment After Ab Interno Trabeculotomy for Glaucoma.

We describe a case of serous retinal detachment (SRD) with ciliochoroidal detachment (CCD) that persisted for 2 years and 7 months after minimally invasive glaucoma surgery (MIGS). A 71-year-old woman with primary open-angle glaucoma and cataracts had a central corneal thickness of 489 μm/492 μm and an ocular axis length of 24.05 mm/24.30 mm. She underwent phacoemulsification and intraocular lens implantation in the right eye (OD), along with goniosynechialysis and microhook ab interno trabeculotomy. Postoperative intraocular pressure was 4-6 mmHg in the OD. Five months later, SRD was observed temporally and inferiorly to the macula, with increased choroidal thickness. Best-corrected visual acuity at 5 months was (1.2)/(1.2) (right eye [OD]/left eye [OS]), and intraocular pressure was 6 mmHg/13 mmHg. CCD in the OD was accompanied by choroidal vessel dilation and choroidal vascular hyperpermeability. Two years and 7 months post-surgery, intraocular pressure spiked to 50-54 mmHg but settled at 12 mmHg 1 week later. CCD resolved, and choroidal folds and SRD disappeared, with decreased choroid thickness. Two years and 10 months postoperatively, there was no SRD recurrence at 10 mmHg on two antiglaucoma eye drops, and best-corrected visual acuity remained stable at (1.0)/(1.0). This case suggests that SRD may result from increased choroidal vessel permeability and retinal pigment epithelium dysfunction secondary to prolonged CCD/low IOP after MIGS. The prolonged disease course may be attributed to the balance between aqueous humor excretion and absorption, influenced by the limited size of the cyclodialysis cleft caused by MIGS.

Efficacy of Using a Vessel Dilator during Surgery to Evaluate Vein Diameter and Predict Radiocephalic Arteriovenous Fistula Maturation and Patency

Background: We use vessel dilators to assess the diameter of the target vein during surgery for arteriovenous fistula (AVF) creation in hemodialysis patients. This study investigates the efficacy of using vein diameter as measured using dilators (surgical diameter; SD) versus that as measured by preoperative ultrasonography (ultrasonographic diameter; UD) to predict postoperative complications and patency. Methods: Sixty-three patients who underwent radiocephalic AVF creation and had measurements of UD and SD were retrospectively analyzed. Cutoff values for UD and SD regarding complications were used to dichotomize the patients into high and low groups for comparisons. Results: The 2-year primary and secondary patency rates overall were 66.5% and 88.9%, respectively. The optimal UD and SD cutoff values were 2.4 and 3.5 mm, respectively. The 2-year primary patency rate was higher in the high-SD group than the low-SD group (88.2% vs. 58.6%; p = 0.0426). The 2-year secondary patency rate was significantly higher in the high-UD/high-SD group than the low-UD/low-SD group (91.7% vs. 68.4%; p = 0.0067). Conclusions: Intraoperative measurement of vein diameter using dilators during AVF creation might be a useful method of predicting patency, particularly when SD is used in combination with UD.

6436 Adrenal Venous Congestion Clinically Mimicking Carcinoma In A Large Degenerated Adrenocortical Adenoma

Abstract Disclosure: K. Ishiwata: None. S. Suzuki: None. S. Watanabe: None. Y. Yamazaki: None. H. Sasano: None. K. Yokote: None. Introduction: A large heterogenous adrenal tumor is often malignant. Only eight reported cases of adrenal adenoma harboring hemorrhage or venous thrombosis have been reported but their details not. We encountered a case of large degenerated adrenocortical adenoma harboring adrenal venous congestion mimicking adrenocortical carcinoma. Case: Adrenal tumor was incidentally detected in a 71-year-old woman with a history of hypertension, dyslipidemia, and osteoporosis in her regular health check-up. Abdominal CT and MRI demonstrated a heterogenous mass measuring 7.6 cm with peripheral enhancement in the left adrenal gland. [1]3[1]I-adosterol scintigraphy revealed accumulation only in the left tumor margins with no accumulation in [1]8F-FDG-PET scan. Results of endocrinologic evaluation were consistent with subclinical Cushing syndrome. The large size and heterogeneous nature of the mass clinically suggested adrenocortical malignancy, and left laparoscopic adrenalectomy was subsequently performed. The resected left adrenal lesion was encapsulated and measured 6.5 x 6.3 x 5.8 cm appearing almost black and partially yellow on the cut surface. Microscopically, the nodule was composed of SF-1 positive, clear cortical cells with abundant hyaline stroma containing numerous dilated veins with CD31/34-positive endothelial cells, and no foci of necrosis or hemorrhage were detected. The tumor cells above were positive for steroidogenic enzymes including CTP17, HSD3β and CYP11B1 but negative for CYP11B2. Ki-67 labeling index was &amp;lt;2% in the tumor. The criteria of Weiss (0 out of 9) revealed that the tumor was cortisol-producing adrenocortical adenoma. Discussion: In this case, clusters of SF1-positive cortisol producing adrenocortical adenoma cells were present in the hyalinized stroma containing many dilated blood vessels. These findings indicated that those histological features were caused by ischemic degeneration due to intratumoral circulatory disturbance, which clinically simulated adrenocortical carcinoma. Conclusion: We have experienced a very rare case of cortisol-producing adrenocortical adenoma with adrenal venous congestion, resulting in marked enlargement of the lesion. Presentation: 6/3/2024

Effect of hot saline irrigation on the operative field during endoscopic sinus surgery: a randomized controlled trial.

Control of bleeding is very important during endoscopic sinus surgery. Saline heated up to 50°C causes dilatation of vessels and edema without nasal mucosa necrosis. It also promotes the clotting cascade so helps in having a bloodless procedure. This randomized controlled trial was conducted on 60 patients divided into two groups (30 each). Group A was the interventional group in which patients were irrigated with saline of 50°C during surgery. Group B was the control group where room-temperature saline was used. The operative field was assessed using the Boezaart score, duration of surgery, and bleeding in ml. The Boezaart score in group A came out to be 2.23 ± 0.72 whereas it was 3.43 ± 0.72 in group B. Most of the patients who were in the interventional group had their surgery completed within 60min with comparatively less bleeding (mean bleeding = 221.83ml). Patients of the control group had increased duration of surgery mostly and bleeding (mean = 265.67ml). Our study showed a strong correlation amongst the Boezaart score, duration of surgery, and bleeding in ml with a p value of < 0.001 where all three variables significantly improved in the interventional group due to a good operative field provided by warm saline heated up to 50°C. Normal saline heated up to 50°C is a cost-effective way to achieve a bloodless operative field during endoscopic sinus surgery. Reduced bleeding also decreases the duration of surgery.

Quantitative evaluation of microenvironmental changes and efficacy of cupping therapy under different pressures based on photoacoustic imaging

Cupping therapy, a traditional Chinese medicinal practice, has been subjected to scientific scrutiny to validate its effects on local tissue microenvironments. This study provides a quantitative assessment of cupping therapy at different negative pressures using photoacoustic imaging. Low-pressure cupping (-20 kPa) significantly improved local blood circulation, evidenced by increased hemoglobin oxygen saturation and vessel dilation that normalized within two hours. In contrast, high-pressure cupping (-30 kPa) led to capillary rupture, bleeding, and tissue edema, similar to the clinical presentation of cupping bruises. Additionally, our research unveiled that −20 kPa cupping expedited the clearance of indocyanine green dye, suggesting enhanced lymphatic drainage, which was further supported by fluorescence imaging. This indicates a potential mechanism for cupping's pain relief effects. Moreover, cupping showed promising results in improving sepsis outcomes in mice, potentially due to its anti-inflammatory properties. This study establishes a foundation for the objective evaluation of cupping therapy, demonstrating that low-pressure cupping is effective in promoting blood and lymphatic flow while minimizing tissue damage, thereby offering a safer therapeutic approach.

Extramedullary recurrence of acute lymphoblastic leukemia with initial presentation as a conjunctival mass

A 32-year-old man presented with a 1-month history of redness, blurred vision, and discharge in his right eye. His medical history was remarkable for T-cell acute lymphoblastic leukemia (ALL), and he was in complete remission and on immunosuppression at the time of presentation. Physical exam revealed dilated vessels, conjunctival mass, and diffuse injection in the superonasal quadrant with no other abnormal findings. The patient was started on topical steroids, which showed no improvement. Incisional biopsy was performed, revealing recurrence of ALL. Subsequent imaging unveiled bilateral orbital masses. He was treated with palliative radiation, which resulted in complete response without ocular side effects.