Lack Of Calcification Research Articles

Clinicopathological and Ultrasonographic Characteristics of Breast Cancer in Young Women.

Purpose: The early detection of breast cancer in women under the age of 40 has posed significant challenges. This can be attributed in part to the limited research conducted on the breast cancer in this age group, particularly with regards to large sample sizes. We aimed to address this gap by analyzing and comparing the ultrasound imaging and pathological characteristics of breast cancer in women aged under 40 and those aged 40 and above. Methods: A retrospective assessment was conducted to examine the ultrasound imaging and clinicopathologic characteristics of 555 women with surgically confirmed breast cancers. The patient cohort consisted of 160 individuals below the age of 40 and 395 individuals aged 40 years and above. Results: Our study identified the breast cancer in patients under 40 years was more likely to show regular shape (p = 0.043) compared with tumors in patients who were 40 years and over. Furthermore, in young female patients (<40 years), irregular shape was correlated with the HER2-enriched type (p = 0.02), circumscribed margin (p = 0.001), and a lack of calcifications (p = 0.02) were associated with the triple-negative type. In another group (≥40 years), only a lack of calcifications (p = 0.003) were associated with the triple-negative type. Conclusion: Breast cancer in women under the age of 40 exhibits distinct ultrasonographic characteristics patterns that vary across different immunophenotypes, which may provide certain predictive information for physicians.

A Valved Expanded Polytetrafluoroethylene Conduit can Acquire Endothelium After Implantation.

We demonstrate histopathology, neointimal proliferation, and neo-endothelialization in an explanted valved expanded polytetrafluoroethylene (ePTFE) conduit 40 months postimplantation that was void of calcification and inflammation, confirmed by CD-31 positivity on immunohistochemistry. Grossly, there was no distortion with preserved leaflets and lack of calcification. Good biocompatibility, nonreactivity, and low antigenicity, combined with neointimal and endothelial layer generation within the conduit might explain the low infection rates and minimal thrombogenicity. These findings support the use of handmade, valved ePTFE conduits as an economically viable option as a right ventricle to pulmonary artery conduit.

Transcatheter heart valve interventions for patients with rheumatic heart disease.

Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent. Is it time to consider less invasive alternatives to conventional valve surgery? Several anatomical and pathological differences exist between degenerative and rheumatic valves, including percutaneous valve landing zones. These are poorly documented and may require dedicated solutions when considering percutaneous intervention. Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for severe mitral stenosis (MS) but is reserved for patients with suitable valve anatomy without significant mitral regurgitation (MR), the commonest lesion in RHD. Valvuloplasty also rarely offers a durable solution for patients with rheumatic aortic stenosis (AS) or aortic regurgitation (AR). MR and AR pose unique challenges to successful transcatheter valve implantation as landing zone calcification, so central in docking transcatheter aortic valves in degenerative AS, is often lacking. Surgery in young RHD patients requires mechanical prostheses for durability but morbidity and mortality from both thrombotic complications and bleeding on Warfarin remains excessively high. Also, redo surgery rates are high for progression of aortic valve disease in patients with prior mitral valve replacement (MVR). Transcatheter treatments may offer a solution to anticoagulation problems and address reoperation in patients with prior MVR or failing ventricles, but would have to be tailored to the rheumatic environment. The high prevalence of MR and AR, lack of calcification and other unique anatomical challenges remain. Improvements in tissue durability, the development of novel synthetic valve leaflet materials, dedicated delivery systems and docking stations or anchoring systems to securely land the transcatheter devices, would all require attention. We review the epidemiology of RHD and discuss anatomical differences between rheumatic valves and other pathologies with a view to transcatheter solutions. The shortcomings of current RHD management, including current transcatheter treatments, will be discussed and finally we look at future developments in the field.

Impact of Isometric Exercise in Adolescents With End Stage Kidney Disease and Unsuitable Vessels For An Autologous Arteriovenous Fistula.

Despite the lack of calcification, to perform a native Arteriovenous Fistula (AVF) in young patients may pose a challenge due to small vessel diameter. We report a case series with no options of AVF in which vessel caliber improvement after isometric exercise allowed for radiocephalic fistula creation in all of them. Since 2017 to 2019, four patients were referred to our unit to create an AVF. Following a first assessment with physical examination and doppler ultrasound, none of them were eligible for AVF performance due to small vessel caliber. Once they were considered unsuitable for it, they started an isometric exercise program. Age ranged from 13 to 19years. There were three males and one female. Two were in predialysis and two in hemodialysis program. Initial diameters of the forearm cephalic vein and the radial artery respectively were: case A < 1.5/2.3mm, case B 1.5/1.6mm, case C < 1.5/1.6mm and case D 2.1/1.3mm. Median duration of exercise program was 13weeks (range 5-23). Post-exercise vessel diameters were: case A 2.7/2.3mm, case B 2.5/2mm, case C 2.8/1.8mm and case D 2.7/2mm. Radiocephalic AVF were performed in the four cases. After a median follow up of 19 months (range 9-30months), 75% of patients required further interventions but all of them had a functional AVF. In these four cases isometric preoperative exercise allowed the creation of AVF. Without the improvement in vessel diameter observed afterwards, all of them would have been rejected for AVF performance. Despite the high rate of adjunctive interventions needed, given the safety of the program and the potential risks of Central Venous Catheters, we consider it a valuable option.

Differential diagnosis of non-diffuse primary thyroid lymphoma and papillary thyroid carcinoma by ultrasound combined with computed tomography

BackgroundPrimary thyroid lymphoma (PTL) and papillary thyroid carcinoma (PTC) are both thyroid malignancies, but their therapeutic methods and prognosis are different. This study aims to explore their sonographic and computed tomography(CT)features, and to improve the early diagnosis rate.MethodsThe clinical and imaging data of 50 patients with non-diffuse PTL and 100 patients with PTC confirmed by pathology were retrospectively analysed.ResultsOf the 150 patients, from the perspective of clinical data, between non-diffuse PTL and PTC patients existed significant difference in age, maximum diameter of nodule, asymmetric enlargement and Hashimoto’s thyroiditis (P < 0.001), but not in gender ratio, echo texture, cystic change and anteroposterior-to-transverse ratio (P > 0.05). With respect to sonographic feature, non-diffuse PTL patients had a higher proportion than PTC patients in markedly hypoechoic, internal linear echogenic strands, posterior echo enhancement, rich vascularity, lack of calcification and homogeneous enhancement, with statistically significant difference (P < 0.05), while PTC patients had a higher proportion than non-diffuse PTL patients in irregular border, circumscribed margin, capsular invasion and significant enhancement, with statistically significant difference (P < 0.001). With respect to CT feature, non-diffuse PTL patients were significantly different from PTC patients in the non-contrast CT value mean, venous phase CT value mean, enhanced intensity and homogeneity of nodules (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 1.226, 95%CI:1.056 ~ 1.423, P = 0.007), posterior echo enhancement (OR = 51.152, 95%CI: 2.934 ~ 891.738, P = 0.007), lack of calcification (OR = 0.013, 95%CI: 0.000 ~ 0.400, P = 0.013) and homogeneous enhancement (OR = 0.020, 95%CI: 0.001 ~ 0.507, P = 0.018) were independent risk factors.ConclusionsSonographic and CT features of the presence of posterior echo enhancement, lack of calcification and homogeneous enhancement were valuable to distinguishing non-diffuse PTL from PTC.

Ontogeny and Early Steps of the Calcification Process in Coralline Algae Lithophyllum corallinae (Florideophyceae, Rhodophyta)

Coralline algae (Rhodophyta, Florideophyceae) are one of the most abundant organisms in the hard-bottom marine photic zone where they provide settlement substrates, structure and shelter on rocky substrates. Coralline algae also play important roles in tropical reefs, both cementing corals together and producing substantial amounts of calcium carbonate. The ecological roles of coralline algae in the marine environment are related to the biomineralization process that occurs in the cell walls. Currently, this group of algae is receiving renewed attention from researchers from different fields, especially due to possible effects of climate changes over its magnesium calcite skeleton. Despite this renewed attention, we still have poor information regarding the first steps of coralline algae ontogeny and calcification. The aim of this study was to describe the earlier steps ofLithophyllum corallinaedevelopment and its calcification process. Algae were collected at Vermelha Beach, Rio de Janeiro city. Adult crusts released spores that settled over microscope slides. The germinating spores were analyzed by Polarizing Light Microscopy, Scanning Electron Microscopy, Energy Dispersive Spectroscopy, Transmission Electron Microscopy and Atomic Force Microscopy. Results showed that cell walls mineralization begins at third spore cell division (8 cells specimen), evidenced by changes in light polarization, elemental composition and hardness, restricted to the cell walls of the innermost part of the developing spore. Nanopores in calcite crystals structure were identified, evidencing macromolecules occlusion, a feature especially important to prevent calcite skeleton cracking in high-energy environments. The beginning of this process could be related to spore size, availability of organic matrix and energy from photosynthesis. All the analysis also confirmed the lack of calcification in the cell walls of the outermost part of the germinating spore, which allows the growth of the individual; but mainly indicates a high level of control in coralline algae mineralization process, representing a relevant information in future studies on coralline algae calcification, including those testing climate changes scenarios.

Diagnostic performance of superb microvascular imaging combined with shear-wave elastography in distinguishing invasive ductal carcinoma molecular subtypes

IntroductionTo explore the diagnostic value of combining superb microvascular imaging (SMI), shear-wave elastography (SWE), and Breast Imaging Reporting and Data System (BI-RADS) to distinguish different molecular subtypes of invasive ductal carcinoma (IDC).Material and methodsA total of 239 surgically confirmed IDC masses in 201 patients underwent conventional ultrasound, SMI, and SWE examination, the information such as echo pattern, posterior features, margins, SMI pixels, and hardness of the masses was recorded. According to the St. Gallen standard, breast masses were classified as Luminal A, Luminal B, HER2 overexpression, and triple-negative subtype. We further explored the differences between different molecular subtypes of IDC.ResultsLuminal A subtype had the following characteristics: low histologic grade, posterior acoustic shadowing (p= 0.019), spiculated margins (p&lt;0.001) , and relatively soft. Luminal B subtype was characterized by low histological grade (p &lt;0.0001), posterior acoustic shadowing or indifference, and indistinct margins. HER2 overexpression breast cancers were characterized by high histological grade, enhanced posterior acoustics or indifference, calcifications (p= 0.005), spiculated or indistinct margins, vascularity (p=0.005), and relative stiffness. Triple-negative breast cancers had the characteristics of high histological grade, posterior echogenic enhancement, lack of calcifications, circumscribed or microlobulated margins, low blood flow signals, and stiff tissue (p=0.013).ConclusionsOur study demonstrated the significant differences and trends among the IDC four subtypes by the combined application of SMI, SWE, and BI-RADS lexicon, which are of great significance for early diagnosis, selection of treatment methods, and evaluation of prognosis of IDC.

Diffuse infiltrating retinoblastoma: A diagnostic conundrum

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

Deciphering voids in Dasycladales, the case of Dragastanella transylvanica, a new Lower Cretaceous triploporellacean genus and species from Romania

AbstractDragastanella transylvanica n. gen. n. sp. is described. Its calcified skeleton contains numerous voids, partly related to the molds of soft parts of the alga, but also related to lack of calcification. Interpretation of these voids, especially their attribution to original structures (e.g., primary lateral versus reproductive organ), has important implications for the taxonomic position of the alga, even at the family level. Examination of key sections that include the boundary between sterile and fertile parts of the alga excludes the occurrence of external reproductive organs. Unusual, paired pores in the outer part of the mineralized skeleton reflect an asymmetry within the whorl, excluding the presence of secondary laterals. The alga is characterized by a cylindrical to club-shaped thallus bearing only phloiophorous primary laterals arranged in whorls and flaring outwards, forming a cortex. Mineralized lenticular reproductive organs containing cysts set in the equatorial plane (Russoella-type gametophores) occur inside primary laterals (cladosporous arrangement of the reproductive organs). These characters support establishment of the new genus Dragastanella. Dragastanella transylvanica n. gen. n. sp. resembles species previously referred to Zittelina (Zittelina hispanica and Zittelina massei) and Triploporella (Triploporella matesina and Triploporella carpatica). Except for Triploporella carpatica, whose mineralized skeleton does not permit confident attribution to either Triploporella or Dragastanella n. gen., the other species must be ascribed to Dragastanella n. gen. Therefore, the following new combinations are proposed: Dragastanella hispanica n. comb., Dragastanella massei n. comb., and Dragastanella matesina n. comb. Despite widely overlapping biometrical measurements, these species can be differentiated by the size and location of their reproductive organs, the pattern of calcification around the primary laterals, and relationships among structural parameters such as the size of laterals, number of laterals per whorl, and distance between whorls.

Rheumatic Bicuspid Aortic Valve Causing Device Embolization during Transcatheter Aortic Valve Replacement

Transcatheter aortic valve replacement (TAVR) has emerged as a feasible alternative for treatment of severe aortic stenosis with comparable outcomes to surgical aortic valve replacement (SAVR) in recent years. We present a case of device embolization in the left ventricular outflow tract (LVOT) during TAVR in a patient with severe aortic stenosis that required emergent surgical intervention. During the open-heart surgery for embolized prosthesis extraction and SAVR, both TEE exam and surgical specimen demonstrated bicuspid aortic valve and rheumatic nature of the valve with lack of calcification, which were identified to be the two main factors that contributed to the complication. In which the insufficient annular calcification increases the risk of device embolization due to lack of an adequate landing zone for device anchoring, and the anatomy of bicuspid valve contributes to the complication due to its associated large annular size and horizontal aorta. This case highlights device embolization as one possible complication of TAVR which is associated with substantial morbidity and mortality, the clinical management process was thoroughly documented with aortic angiography and transoesophageal echocardiography imaging.

Fabrication and in-vitro characterization of a polymeric aortic valve for minimally invasive valve replacement

The valve replacement therapy is the standard treatment for severe heart valve diseases. Nowadays, two types of commercial prosthesis are available: mechanical and biological, but both of them have severe limitations. Moreover, alternative therapeutic approach for valve replacement, based on minimally invasive techniques (MIAVR), motivates the search for new valve materials. In this study a polyurethane-based self-expandable tri-leaflets heart valve compatible with MIAVR procedure is proposed. The device is based on the development, fabrication and characterization of three different elements: the leaflets, the polymeric stent for supporting the leaflets, and the external metallic stent for anchoring the valve to the native aortic root. The polymeric stent and the valve leaflets were fabricated using a thermoplastic silicone-polycarbonate-urethane using 3D printing and spray technology while the external metallic stent was made in nickel titanium (Nitinol) to obtain a self-expandable valve after the crimping process. The three elements were assembled in the completed device and tested by crimping, fatigue and fluid-dynamic test. The novel polymeric valve proposed showed promising results about valve crimping capabilities, durability and fluid dynamic performances. This approach could offer advantages such as low cost and to produce a tailor-made device basing on patient's imaging data. Moreover, the selected biomaterial offers the potential to have a device that could need of permanent anticoagulation and lack of calcification.

Percutaneous axillary artery access for fenestrated and branched thoracoabdominal endovascular repair

ObjectiveThe aim of this study was to assess the safety and effectiveness of upper extremity access (UEA) with percutaneous closure of the axillary artery (AxA) during endovascular treatment of thoracoabdominal aortic aneurysms with fenestrated and branched endografts. MethodsBetween January 2014 and 2017, 34 out of 37 patients (92%) required UEA during a staged branched and fenestrated endovascular approach. A percutaneous AxA (pAxA) approach was used in 14 consecutive patients (41%) with the off-label use of two Perclose ProGlide (Abbott Vascular, Santa Clara, Calif) devices. The results of patients who had received a pAxA access were analyzed; technical success was defined as successful arterial closure with no evidence of persistent bleeding or arterial occlusion requiring secondary interventions. Early (30 days) and short-term (6 months) success rates were recorded. The anatomic characteristics of the AxA of the entire cohort (34 cases) were studied. ResultsPrimary technical success of pAxA was 100%; in one case, an adjunctive Perclose ProGlide device was used to achieve complete closure. No secondary open or endovascular procedures were required. At predischarge computed tomography, no intimal defects, pseudoaneurysms, or signs of bleeding were observed, and all patients were discharged without neurologic deficits related to the AxA puncture site. All 14 patients are alive at follow-up, and 9 of 14 patients completed a 6-month clinical follow-up with computed tomography examination; no late complications were observed at the site of UEA percutaneous repair. With regard to the anatomic characteristics of the AxA, the vessel diameters in the first and third segments were statistically different (P < .001) with a median difference of 1.5 mm (1.0-2.0 mm), with no differences between the right and left sides. The distance between the end of the first segment of the AxA and the origin from the aortic arch was statistically different between the right and left sides, with a median difference of 36 mm (17-50 mm). A positive linear correlation was found between the diameter of the AxA and the height of the patients. ConclusionsAxA is adequate in terms of both caliber and lack of calcifications as an access vessel for large-sheath catheterizations, and it might be considered an alternative UEA for complex aortic endovascular procedures thanks to its proximity to visceral target vessels. In this preliminary experience, percutaneous closure of AxA access with the Perclose ProGlide device is clinically safe and technically feasible with high rates of success.

Comparison of sonographic characteristics of primary thyroid lymphoma and anaplastic thyroid carcinoma.

Although primary thyroid lymphoma (PTL) and anaplastic thyroid carcinoma (ATC) both account for a rare portion of the morbidity of all thyroid malignancies, the therapeutic methods and prognosis for these two diseases are different. The purpose of this study was to investigate the sonographic characteristics of PTL and ATC and to compare the sonographic findings of PTL and ATC. The study included 42 patients with histopathologically proven PTL (n=27) and ATC (n=15). The Clinical characteristics and sonographic findings were retrospectively reviewed and compared between the two groups. The mean age of patients with ATC was not significantly different from that in patients with PTL (P=0.601). The female-to-male ratio of patients with ATC was significantly lower than that of patients with PTL (P=0.029). Both PTL and ATC commonly present as a relatively large, solid mass on sonography with compressive symptoms, in which hoarseness was seen more frequently in ATC group (66.7%) than in PTL group (14.8%) (P=0.001). There is no significant difference in thyroid size, nodular size, margin, shape, echo texture, echogenicity, cystic change, vascularity and local invasion on sonography between ATC and PTL groups. Echogenic strands, markedly hypoechoic and enhanced posterior echo were seen more frequently in PTL group (92.6%, 92.6%, and 85.2%, respectively) than those in ATC group (6.7%, 60.0%, and 33.3%, respectively) (P<0.05), and calcification was seen more frequently in ATC group (80.0%) than in PTL group (0%) (P<0.001). Three ultrasound patterns were observed for PTL including diffuse type (25.9%), nodular type (48.2%) and mixed type (25.9%), while all ATC cases presented with nodular type (100.0%). Associated Hashimoto's thyroiditis occurred more frequently in PTL group (59.3%) than in ATC group (20.0%) (P=0.023). Certain sonographic features as a markedly hypoechogenicity, the presence of an enhanced posterior echo and linear echogenic strands, lack of calcification and associated Hashimoto's thyroiditis were valuable for distinguishing PTL from ATC. In contrast, heterogeneous echogenicity, uncircumscribed margin, irregular shape, and vascular pattern were not specific features for differential diagnosis.

Pancreatic cysts: What imaging characteristics are associated with development of pancreatic ductal adenocarcinoma?

PurposeTo assess relationship between pancreatic cysts (PC) and pancreatic ductal adenocarcinoma (PDAC) and to compare imaging features of PC in subjects who develop PDAC and those who do not. Material and methodsThis case-control IRB-approved HIPAA-compliant study included patients with PDAC (cases) and lung cancer (controls), diagnosed between 1/1/05–1/1/14. The most recent abdominal CT/MR of each patient done >6months prior to cancer diagnosis date was reviewed by radiologist blinded to case/control status. Presence of PC, number and size of largest PC, presence of main pancreatic duct (MPD) dilatation (MPD >3mm) were recorded. Simple PC was defined as lack of calcifications, septations and enhancement. Logistic regression models with binary outcome of PDAC were constructed. ResultsThere were 88 cases and 273 controls with mean ages of 69.6 years (±10.3) and 69.8 years (±12.0), respectively (p=0.864). PC were present in 21.6% (19/88) cases and in 9.2% (25/273) controls (p=0.002). The OR of PC for development of PDAC was 2.83, adjusting for age, sex and race (p=0.001). Mean PC size was 14.8mm (±8.7) in cases and 7.6mm (±8.0) in controls (p=0.007). PC were solitary in 6 (31.6%) of 19 cases and 21 (84.0%) of 25 controls (p=0.001). There was no significant difference in proportions of simple cysts or MPD dilatation between cases and controls. Multiple PC had 8.2 times increased odds of PDAC compared with solitary PC, adjusting for cyst size (p=0.007). ConclusionMultiple PC are associated with 8.2 times higher odds of PDAC compared with solitary PC.

TAVI for aortic regurgitation – India's first case with Corevalve Evolut R

Transcatheter Aortic Valve Implantation (TAVI) is a well-described treatment for symptomatic calcific severe aortic stenosis. However, TAVI technology is being increasingly used around the world to treat selected cases of severe aortic regurgitation (AR). One of the main limitations of using TAVI technology for AR is the lack of calcification, which is common in such cases. This makes anchoring of a TAVI prosthesis to the aortic annulus difficult and risks displacement or embolization. However, with the availability of recapturable and repositionable TAVI technologies, these limitations have been overcome to a large extent. This is the first Corevalve Evolut R device that was used in India and the first TAVI to treat AR in India.

Pediatric focally pigmented choroidal melanoma: Imaging with pathological correlation

We report a 9-year-old-boy with no predisposing factors who presented with left eye leukocoria from a complete retinal detachment at ophthalmoscopy. Imaging showed an intraocular dome-shaped mass of low to moderate internal reflectivity at ultrasound, low T2-weighted signal intensity, lack of T1-weighted high signal intensity, and subtle gadolinium-enhancement at magnetic resonance imaging, and lack of calcifications at computed tomography. Due to the rapid extensive intraocular growth, the affected eye was enucleated. Pathologic examination showed a choroidal melanoma with only focal pigmentation. Despite its very rare incidence in the pediatric population, choroidal melanoma should be included in the differential diagnosis of leukocoria.

Transcatheter aortic valve implantation (TAVI) in a patient with severe aortic insufficiency of aortic valve homograft

We present the case of a 64-year-old female who was admitted to our centre with severe aortic insufficiency and advanced heart failure symptoms (NYHA class III–IV). Her medical history included: surgical homograft aortic valve replacement due to severe aortic insufficiency 14 years ago, chronic atrial fibrillation, and hypothyroidism. The patient’s logistic EuroSCORE was 32%, EuroSCORE II 9.1%, and STS score 3.95%. Preprocedural transthoracic echocardiographic examination revealed akinesis of the basal and mid segments of interventricular septum, global hypokinesis of remaining segments with ejection fraction of 19%, enlargement of the left ventricle and atrium (diameter of 68 and 43 mm, respectively), regurgitant orifice area of 0.3 cm2, regurgitant volume of 58 mL, and regurgitant jet width to left ventricular outflow tract ratio of 66% (Fig. 1). An additional transoesophageal echocardiographic examination was performed for more precise measurement: this showed aortic annulus diameter of 24 mm. Angiography and computed tomography were also performed, showing no lesions in either the coronary or peripheral arteries. On the basis of the abovementioned clinical conditions, the Heart Team decided to refer the patient to transcatheter aortic valve implantation (TAVI) via femoral access. The procedure was performed under general anaesthesia with a temporary pacemaker placed through the jugular vein and vascular access obtained with 18 Fr sheath by puncture of the right femoral artery. Due to lack of calcifications, two pig-tail catheters were placed in order to mark the plane of the annulus (Fig. 2) and 29 mm Medtronic CoreValveTM bioprosthesis was implanted under rapid pacing. Despite these preventive measures, the final position of prosthesis was too low with moderate-to-severe aortic insufficiency (Fig. 3) that persisted even after postdilatation with a 28 mm balloon. Therefore, the decision to implant another 29 mm CoreValve 10 to 15 mm higher was made. Finally, in control imaging, only a mild paravalvular leak was present (Fig. 4), and on discharge the ejection fraction had improved to 43%. TAVI is an effective treatment option for severe aortic stenosis in inoperable and high-risk patients. However, failure (mostly insufficiency) of a previous homograft aortic valve poses a challenge for any interventional treatment. In selected patients, TAVI can be a feasible alternative for high risk re-operation. TAVI may also be considered in some cases of native aortic insufficiency where there is favourable anatomy.

Analysis of some risk factors of coronary and valvular calcification in peritoneal dialysis

AbstractOBJECTIVEOur study was performed to analyze risk factors for coronary artery calcification (CAC) and valvular calcification (VC) in peritoneally dialyzed patients, as well as the frequency of fatal cardiovascular complications.METHODSThe study was performed on 102 peritoneal dialyzed patients (mean time of dialysis: 37.3 ± 23 months). Patients were divided depending on the severity of calcification into three groups: A, lack of calcification; B, CAC up to 400 mm3; and C, CAC &gt;400 mm3. CAC and VC were measured by means of computed tomography. The following risk factors for CAC and VC were analyzed: age, gender, time of peritoneal dialysis, and levels of calcium, phosphates, calcium × phosphorus product (Ca × P), C‐reactive protein (CRP), fibrinogen, fetuin‐A, and parathormone (PTH).RESULTSPositive correlation was found between CAC and VC expressed by Agatston and volumetric score, and serum levels of CRP and fibrinogen and patient age. In patients with CAC and VC, serum levels of phosphorus and Ca × P were significantly higher; however, such significance was not observed in patients with CAC only. Serum fetuin‐A was decreased in all study groups, and was significantly lower in patients with CAC and VC than in patients with CAC only. Cardiovascular complications were significantly more frequent and mortality was higher in group C than in groups A and B.CONCLUSIONSIn peritoneally dialyzed patients, CAC accompanied by VC is a high risk factor for mortality resulting from cardiovascular complications.

Melanocytic matricoma. Report of a further case with clinicopathological and immunohistochemical findings, differential diagnosis and review of the literature.

Melanocytic matricoma is a rare recently described lesion. It usually presents as a pigmented, dark-papular, crusted lesion on sun-damaged skin of adult patients. Histopathologically, these lesions are characterized by well-circumscribed nodules composed of matrical and supramatrical cells with clustered shadow cells, and admixed pigmented dendritic melanocytes. It differs from matricomas and pilomatricomas by its lack of calcification, cyst formation, granulomas, and connections to the epidermis and other adnexal structures. The clinical differential diagnosis includes hemangioma, pigmented basal cell carcinoma, and melanoma. Melanocytic matricoma presumably is the representation of an epithelial-melanocytic interaction in the anagen phase of the hair cycle. An extensive search of the medical literature revealed 11 reports of benign melanocytic matricomas and 5 malignant counterparts. We report an additional case of melanocytic matricoma with discussion of clinicopathologic features and differential diagnosis.

Carotid Atherosclerotic Calcification Does Not Result in High Signal Intensity in MR Imaging of Intraplaque Hemorrhage

Calcium can potentially shorten T1, generating high signal intensity in GREs. Because IPH appears as high signal intensity in MRIPH and the surface effects of calcium can potentially shorten T1 of surrounding water protons, the purpose of this study was to evaluate whether the high signal intensity seen on MRIPH could be attributed solely to IPH and not calcification. Eleven patients undergoing carotid endarterectomy were imaged by using MRIPH. Calcification was assessed by scanning respective endarterectomy specimens with a tabletop MicroCT. MRIPH/MicroCT correlation used an 8-segment template. Two readers evaluated images from both modalities. Agreement between MRIPH/MicroCT was measured by calculating Cohen κ. High signal intensity was seen in 58.8% and 68.9% (readers 1 and 2, respectively) of MRIPH segments, whereas calcification was seen in 44.7% and 32.1% (readers 1 and 2, respectively) of MicroCT segments. High signal intensity seen by MRIPH showed very good but inverse agreement to calcification (κ = -0.90; P < .0001, 95% CI, -0.93 to -0.86, reader 1; and κ = -0.74; P < .0001; 95% CI, -0.81 to -0.69, reader 2). Most interesting, high signal intensity demonstrated excellent agreement with lack of calcification on MicroCT (κ = 0.92; P < .0001; 95% CI, 0.89-0.94, reader 1; and κ = 0.97; P < .0001; 95% CI, 0.96-0.99, reader 2). In a very small number of segments, high signal intensity was seen in MRIPH, and calcification was seen on MicroCT; however, these represented a very small proportion of segments with high signal intensity (5.9% and 1.6%, readers 1 and 2, respectively). High signal intensity, therefore, reliably identified IPH, known to describe complicated plaque, rather than calcification, which is increasingly recognized as identifying more stable vascular disease.