Vascular Causes Research Articles

Endovascular Treatment of Long Femoropopliteal Lesions with Contiguous Bare Metal Stents

Recent controversies on the use of drug coated/eluting devices in the arteries of the lower extremities renewed the focus on the evaluation of more conventional techniques. The results of the stenting of short and/or intermediate femoro-popliteal lesions are well known, but little data relate to the endovascular treatment of long femoro-popliteal lesions with contiguous bare metal stents (ETLFBS). The objective of this study was to report our results of ETLFBS. Between January 2014 and December 2017, 1233 patients had an infrainguinal angioplasty in our center. The files of patients treated for femoropopliteal lesions longer than 250 mm using extensive stenting with contiguous bare metal stents were reviewed and analyzed. The primary outcome was the 12-month primary patency, defined by the absence of restenosis (≥50%) and/or reintervention on the target lesion. Continuous data were expressed as mean and standard deviation. Survival analysis was carried out according to Kaplan-Meier. Overall, 64 patients aged 80 ± 11 years were included, with 49 (76.6%) presenting with critical limb ischemia. Lesions were classified as TASC D in 54.7% of the cases. The length of the lesions was 295 ± 64 mm and 3 ± 1 stents were implanted. The 30-day mortality was null but two patients (3.1%) presented nonvascular major complications. With a follow-up of 27 ± 17 months, 22 patients (34.3%) died including three of vascular causes. The healing of the trophic disorder was obtained in 77.5% of the cases. The rate of amputation was 10.9%. The 6-, 12-, and 24-month primary patency rates were 79.7%, 66.6%, and 60.9%, respectively. The 6-, 12-, and 24-month rates of freedom from target lesion revascularization were 96.3%, 73.9%, and 71.9%, respectively. The 6-, 12-, and 24-month survival rates were 90.3%, 83.6%, and 65.6%, respectively. The 12-month primary patency rate of ETLFBS is acceptable. This strategy constitutes an acceptable alternative in patients presenting with critical limb ischemia and a limited life expectancy.

Orofacial Dental Pain and Its Management – A General Guide and Systemic Review

Pain is one of the main symptoms for which patients seek medical attention. Pain has been designated as the “Fifth vital sign” to mark its importance as health status indicator. Orofacial dental pain may be due to various conditions affecting numerous structures local to or distant to the oral cavity including the meninges, cornea, oral, nasal, sinus mucosa, dentition, musculature, salivary glands and temporomandibular joint. Evidence support the fact that the most commonly experienced orofacial pain is dental in nature. The dental reasons should be well thought of as the first step even in cases where orofacial pain is poorly localized. One of the most common reasons for seeking dental care is said to be pain and dysfunction, usually involving the teeth and surrounding tissue. Musculoskeletal, vascular and neuropathic causes of orofacial pain occur very frequently. Orofacial disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as TMJ disorder pain or headache.

Dabigatran-induced acute liver injury in older patients: case report and literature review

Objective. Dabigatran, a direct inhibitor of thrombin, represents an effective alternative to warfarin. Despite the good tolerance and predictable pharmacokinetic profile, dabigatran may be associated to adverse reactions, including gastrointestinal disorders. Here we report on a case of hepatotoxicity along with an extensive revision of the available literature on dabigatran induced liver injury.Methods & results. An 84 years old man attended the Emergency Department after experiencing fatigue for a few days. He suffered from atrial fibrillation and had been initiated on dabigatran (110 mg bid) in the last four weeks. Clinical examination revealed tachycardia, scleral icterus in the absence of signs of chronic hepatic disease. Blood chemistry showed altered liver function tests: AST 809 IU/L, ALT 1629 IU/L, total bilirubin 2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L. Screening laboratory investigations for infectious, autoimmune or metabolic hepatotoxic pathology were unremarkable. The abdominal ultrasound examination excluded vascular causes, revealing non-homogeneous echo-structure consistent with mild hepatic steatosis. At admission to our Geriatric ward dabigatran was discontinued and fondaparinux was introduced. Resolution of the hepatitis and normalization of blood chemistry was observed within two weeks. Few cases are described regarding hepatotoxicity likely caused by the recent onset of treatment with dabigatran. Conclusions. DOACs associated hepatotoxicity is rare but potentially harmful and should be kept in mind, especially in comorbid patients with unexplained liver injury. The mechanism of liver injury during dabigatran therapy is unknown and, not related to cytochrome P450 enzymes since the drug does not affect CYP450 activity.

박동성 이명의 진단과 치료의 최신 지견

Pulsatile tinnitus (PT), in general, is not related to pathology of the auditory system. Although PT is not as common as non-pulsatile tinnitus, the diagnosis and treatment of PT is important as it is reported to be found in as much as 4% of general population and treatable vascular causes are found in 44~91% of subjects with PT. Three types of vascular origins (arterial, arteriovenous, and venous) of pulsatile tinnitus exist and the main causes of pulsatile tinnitus are related to aberrant/ectopic, stenosis, diverticulum, bony wall dehiscence, or other pathologies of blood vessels, either arterial or venous. Brain MRI with angiography, temporal bone high-resolution CT, Doppler ultrasonography, and classical transfemoral cerebral angiography are radiological diagnostic tools for pulsatile tinnitus, but basic findings at the outpatients’ clinic such as subjective psychoacoustic nature of the PT, otoendoscopic findings, and audiologic features are also very important as these can be of great help for the physicians to obtain presumptive diagnostic impression for each subject with PT. Dehiscence/diverticulum of the sigmoid sinus one of the most common surgically correctable venous cause of PT. Additionally, benign intracranial hypertension is also a very common cause of PT that should not be forgotten in obese PT subjects with normal radiologic findings. In this review, diagnostic steps and appropriate surgical- or interventional management options for each cause of PT will be discussed in detail. (J Clinical Otolaryngol 2021;32:26-39)

8-LB: Risk Profile of Comorbid Diabetes and Benefit of Rivaroxaban in Patients with Critical Limb Ischemia: Insights from VOYAGER PAD

Individuals with diabetes mellitus (DM) have a high risk of peripheral artery disease (PAD), of which critical limb ischemia (CLI) is the most severe manifestation. The VOYAGER PAD trial demonstrated the efficacy of rivaroxaban 2.5mg twice daily plus aspirin for reducing risk of major adverse limb and cardiovascular events (acute limb ischemia, major amputation for vascular cause, myocardial infarction, ischemic stroke or cardiovascular death) in 6,564 PAD patients undergoing revascularization; 1,533 presented with CLI. The risk profile of CLI patients with comorbid DM and whether efficacy and safety of rivaroxaban is consistent in this population has not been described. Overall, 47% of CLI patients (n=716) had comorbid DM at baseline. The HR for the primary outcome at 3 years in CLI patients was 0.85 (CI 0.69-1.05); the risk was higher in DM (28.8%) versus those without (20.7%) although all were high risk; more than 1 in 5 had a first event at 3 years (Figure left). The benefit of rivaroxaban was consistent in CLI patients regardless of DM status as was the bleeding risk. However, due to higher baseline risk, the absolute benefit was greater in those with both CLI and DM vs. CLI alone. In conclusion, in patients with CLI, DM is associated with even greater risk of adverse limb and cardiovascular events. Rivaroxaban provides a robust benefit to reduce this risk in CLI patients having comorbid DM. Disclosure C. C. Low wang: None. M. R. Nehler: Other Relationship; Self; CPCResearch. L. Haskell: Employee; Self; Janssen Research & Development, LLC. S. D. Berkowitz: Employee; Self; Bayer U. S . R. M. Bauersachs: Advisory Panel; Self; Bayer AG, LEO Pharma Inc., Speaker’s Bureau; Self; Bristol-Myers Squibb Company, Pfizer Inc. M. P. Bonaca: Research Support; Self; Grant support to CPC from Amgen, Anthos, AstraZeneca, Bayer, Merck, NovoNordisk, Pfizer, Sanofi, Wraser.

English

BACKGROUND Population based studies indicate that the incidence and prevalence of seizure disorders in adults increase with age, especially in elderly, after the age of 60 years. The underlying etiological spectrum is variable across geographies. Analysis of aetiology of seizure is essential for proper treatment to reduce the morbidity and mortality associated with it. The present study was planned to analyse the aetiology of new onset seizures in adult population (> 18 years of age). METHODS The cross sectional study was carried out in the Department of Medicine of MKCG Medical College & Hospital for a period of two years. 100 consecutive cases of new onset seizures admitted in the in-patient department (indoor / ward) were included in the study as per the inclusion and exclusion criteria. The data was collected by the investigators in a pre-tested Case Record Form. Data analysis was done using Microsoft Excel and GraphPad Prism trial version 7.0. Descriptive statistics were presented as proportions for discrete variables and as mean ± SD for continuous variables. P value of ≤ 0.05 was taken as statistically significant. RESULTS Acute symptomatic seizures accounted for 89 % of cases. Neuro-infection was the leading aetiology in 35 % of cases, followed by cerebrovascular accidents (30 %) and metabolic causes (10 %). Neurocysticercosis was seen in 11 % cases, followed by meningitis and cerebral malaria. Among the vascular causes, stroke accounted for 20 %. Prevalence of neuro-infection was highest in the age group of 15 - 35 years. 89 % of idiopathic seizures were generalized tonic-clonic seizure (GTCS). The prevalence of status epilepticus was 8 %. CONCLUSIONS Adult onset seizures have a varied spectrum of aetiology. With a thorough history, clinical examination and appropriate investigations, the aetiology can be identified. Accordingly, treatment can be instituted thus reducing the morbidity and mortality associated with it. KEYWORDS Aetiology, New Seizures, Stroke, Vascular, Neuro-Infection

MO395EPIDEMIOLOGY AND OUTCOME OF PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS: ABOUT 230 CASES

Abstract Background and Aims Acute renal injury (ARI) is a frequent pathology. Rarer are the studies dedicated specifically to the subgroup requiring dialysis. The objective of our study is to identify: The epidemiological profiles of patients with ARI requiring dialysis. The course of the dialysis sessions to determine the dialysis’ prescription and the different accidents. Method This is a descriptive cross-sectional study including patients admitted to the different departments of Sousse University Hospitals in Tunisia who presented an ARI requiring emergency dialysis. Our study was conducted from February 2015 until August 2018. The data collected were analysed by the SPSS software. Results During three and a half years, 230 patients presented ARI requiring dialysis. The average age was 60 ± 16 years old. The sex ratio was 1.61. A history of hypertension, diabetes, heart disease, dyslipidaemia, hyperuricemia, uropathy and neoplasia was noted in respectively 34.9%, 27.1%, 21.6%, 22.7%, 25.5%, 22.7% and 14.3% cases. The causes of ARI were dominated by organic, obstructive and functional causes in 66.2%, 21.7% and 7.4% of cases, respectively. For organic causes, we noted acute tubular necrosis in 70.4% of cases, a glomerular cause in 14.5% of cases, an interstitial cause in 7.9% of cases and a vascular cause in 7.2% of cases. Dialysis indications were dominated by severe acidosis, pulmonary oedema, uremic syndrome and hyperkalaemia in 27.4%, 24.3%, 16.5% and 14.3% of cases, respectively. Among our patients, 26.7% presented a hemodynamic instability with catecholamine use in 16.8% of cases and the use of isovolumic connection at the beginning of the session in 21.2% of cases. The median ultrafiltration was 444 ml / hour IQR [166, 67-750] with extremes of 0 to 1333 ml/hour. The median blood flow was 250 ml/min IQR [250-280] with extremes of 180 to 300 ml/min. The median duration of dialysis’ session was 180 minutes IQR [180,240] with extremes of 15 to 360 minutes. We noted dialysis incidents in 12% of dialysis’ sessions. These events were dominated by hypotension, hypoglycaemia, extracorporeal circuit coagulation, death and chest pain in 13.8%, 4.8%, 2.6%, 2.1% and 0.7% of cases, respectively. The cessation of dialysis sessions was noted in 22 sessions (11.1%). Concerning the evolution of patients: 33.1% of patients recovered normal renal function, 23.9% of patients maintained renal failure, 22.2% of patients died and 20.8% of patients were lost from seen or the duration of their follow-up was less than three months not making it possible to conclude as to the chronicity of the renal insufficiency. Conclusion ARI is a common and serious pathology. Dialysis is an important evolutionary step. It is associated with a high risk of progression to chronic renal failure and mortality. Optimal management of ARI is required.

Efficacy and Safety of Rivaroxaban Therapy for Patients With Peripheral Artery Disease: A Systematic Review and Meta-Analysis.

We performed a systematic review and meta-analysis to evaluate the efficacy and safety of rivaroxaban in patients with PAD for the first time. We searched MEDLINE, EMBASE and the Cochrane Library database for randomized controlled trials (RCTs) conducted for PAD. Three trials which contained 14873 patients were included for final meta-analysis. The results showed patients with rivaroxaban was associated with reduction in primary efficacy outcome (RR 0.83; 95% CI 0.76 to 0.90; p < 0.001). The RR was 0.85 (0.71 to 1.01) for patients with rivaroxaban alone and 0.81 (0.74 to 0.89) for those with rivaroxaban plus aspirin (p for heterogeneity between groups = 0.65). Patients with rivaroxaban showed a lower rate of acute limb ischemia (0.56; 0.47 to 0.66; p < 0.001). There was a trend toward a reduction in the rate of major amputation for vascular causes in the rivaroxaban arm (0.81; 0.63 to 1.03; p = 0.08). Compared with control, rivaroxaban therapy did not reduce the risks of myocardial infarction (0.87, 0.73 to 1.04, p = 0.12), ischemic stroke (0.85, CI 0.68 to 1.06, p = 0.15), death from cardiovascular causes (0.99, 0.85 to 1.15, p = 0.91) or death from any cause (1.00, 0.90 to 1.12, p = 0.98). Rivaroxaban therapy was associated with a 1.57-fold higher major bleeding rate as compared with those with aspirin or warfarin alone. Overall, the risks of the primary efficacy outcomes or adverse limb events were significantly lower with rivaroxaban than with aspirin or warfarin alone in patients with PAD. It also points out the significant major bleeding that occur because of such therapies.

Total Ischemic Event Reduction With Rivaroxaban After Peripheral Arterial Revascularization in the VOYAGER PAD Trial

BackgroundPatients with peripheral artery disease (PAD) undergoing lower extremity revascularization (LER) are at high risk of major adverse limb and cardiovascular events. The VOYAGER PAD (Efficacy and Safety of Rivaroxaban in Reducing the Risk of Major Thrombotic Vascular Events in Subjects With Symptomatic Peripheral Artery Disease Undergoing Peripheral Revascularization Procedures of the Lower Extremities) trial demonstrated that rivaroxaban 2.5 mg twice daily reduced first events by 15%. The benefit of rivaroxaban on total (first and subsequent) events in this population is unknown. ObjectivesThis study sought to evaluate the total burden of vascular events in patients with PAD after LER and the efficacy of low-dose rivaroxaban on total events. MethodsVOYAGER PAD randomized patients with PAD undergoing LER to rivaroxaban 2.5 mg twice daily plus aspirin or aspirin alone. The primary endpoint was time to first event of acute limb ischemia, major amputation of a vascular cause, myocardial infarction, ischemic stroke, or cardiovascular death. The current analysis considered all events (first and subsequent) for components of the primary endpoint as well as additional vascular events including peripheral revascularizations and venous thromboembolism. HRs were estimated by marginal proportional hazards models. ResultsAmong 6,564 randomized events, there were 4,714 total first and subsequent vascular events including 1,614 primary endpoint events and 3,100 other vascular events. Rivaroxaban reduced total primary endpoint events (HR: 0.86; 95% CI: 0.75-0.98; P = 0.02) and total vascular events (HR: 0.86; 95% CI: 0.79-0.95; P = 0.003). An estimated 4.4 primary and 12.5 vascular events per 100 participants were avoided with rivaroxaban over 3 years. ConclusionsPatients with symptomatic PAD who are undergoing LER have a high total event burden that is significantly reduced with rivaroxaban. Total event reduction may be a useful metric to quantify the efficacy of rivaroxaban in this setting. (Efficacy and Safety of Rivaroxaban in Reducing the Risk of Major Thrombotic Vascular Events in Subjects With Symptomatic Peripheral Artery Disease Undergoing Peripheral Revascularization Procedures of the Lower Extremities [VOYAGER PAD]; NCT02504216)

CT for Evaluation of Hemoptysis.

Hemoptysis, which is defined as expectoration of blood from the alveoli or airways of the lower respiratory tract, is an alarming clinical symptom with an extensive differential diagnosis. CT has emerged as an important noninvasive tool in the evaluation of patients with hemoptysis, and the authors present a systematic but flexible approach to CT interpretation. The first step in this approach involves identifying findings of parenchymal and airway hemorrhage. The second step is aimed at determining the mechanism of hemoptysis and whether a specific vascular supply can be implicated. Hemoptysis can have primary vascular and secondary vascular causes. Primary vascular mechanisms include chronic systemic vascular hypertrophy, focally damaged vessels, a dysplastic lung parenchyma with systemic arterial supply, arteriovenous malformations and fistulas, and bleeding at the capillary level. Evaluating vascular mechanisms of hemoptysis at CT also entails determining if a specific vascular source can be implicated. Although the bronchial arteries are responsible for most cases of hemoptysis, nonbronchial systemic arteries and the pulmonary arteries are important potential sources of hemoptysis that must be recognized. Secondary vascular mechanisms of hemoptysis include processes that directly destroy the lung parenchyma and processes that directly invade the airway. Understanding and employing this approach allow the diagnostic radiologist to interpret CT examinations accurately in patients with hemoptysis and provide information that is best suited to directing subsequent treatment. ©RSNA, 2021.

A STUDY TO EVALUATE THE ROLE OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN CEREBROVASCULAR ACCIDENT IN THE DARBHANGA MEDICAL COLLEGE AND HOSPITAL

INTRODUCTION:Cerebrovascular accident (commonly called stroke) is dened as an abrupt onset of a neurologic decit that is attributable to a focal vascular cause. Thus, the diagnosis of stroke is clinical and laboratory studies including brain imaging are used to support the diagnosis AIMS AND OBJECTIVES: To evaluate the serum levels of high sensitivity C-reactive protein (hsCRP) in different types of cerebrovascular accidents on admission. MATERIALS AND METHODS: This study was an institution based cross-sectional study designed to investigate the association of hs-CRP levels with stroke and its types in Indian patients. The study was done in the Department of Medicine, Darbhanga Medical College and Hospital, Laheriasarai, Bihar from march 2019 to March 2020. 50 patients of either sex above 12 years of age admitted in Medicine Department of DMCH, Laheriasarai, Bihar with clinically or radiologically diagnosed stroke. RESULT: The mean level of hsCRP (mean ± s.d.) of the cases in our study was 7.65±7.01 with range 1.4 – 26 and the median was 3.7 and 58% of the cases were having level of hsCRP≥3 (p=0.023).Mean level of hsCRPof cases was signicantly higher than that of control (t98=7.25;p=0.001). CONCLUSION:We concluded that hs-CRPlevel is increased in cases of cerebrovascular accident- ischemic as well as haemorrhagic, suggesting an inammatory response in acute cerebrovascular accident. hs-CRP level is increased in patients with ischemic cerebrovascular accident dramatically but not in haemorrhagic cerebrovascular accident which might be considered as useful adjunct method for determining type of stroke in patients with cerebrovascular problems.

The role of MRI in evaluating vascular causes of nonhypoxic–ischemic neonatal encephalopathy

Background Neonatal encephalopathy (NE) is a clinical syndrome characterized by abnormal neurobehavioral status of the newborn. Aim This study was conducted to evaluate the role of MRI in identifying vascular causes of NE. Patients and methods The study was conducted on 50 full-term neonates admitted to the neonatal ICU at Alexandria University Children’s Hospital with clinical picture suggestive of encephalopathy. MRI examinations were performed on a 1.5-T General Electric (GE) machine. Results In the current study, the causes of non-hypoxic–ischemic encephalopathy NE were categorized into six groups, each group displayed specific MRI features. P value was calculated, and the results revealed that MRI was successful in reaching the final diagnosis with P value of 0.045, confidence interval 95%, and RRF=1.385. Conclusion Those with vascular insults had 1.39 times the rate of reaching a final diagnosis compared with those with nonvascular insults.

Study of clinical and etiological profile of hypertensive emergencies in children admitted in pediatric emergency department

Background: Hypertension (HTN) in children, all though an uncommon entity is associated with end-organ damage. With increasing prevalence of hypertension and obesity in children; hypertensive emergencies are also increasing over recent years and screening is must. The primary objective of this study was to determine the incidence of hypertensive emergencies, the clinical presentation and etiological diagnosis at different age groups and to access the real burden of primary hypertension in causing hypertensive emergencies in children.Methods: This study was a prospective, descriptive, analytical cohort study done on children attending the emergency department of pediatrics, government general hospital, a tertiary referral pediatric center attached to Kurnool medical college, Kurnool, over a period of 18 months i.e., from january2016 to June 2017. Data was collected in a pre-determined proforma after institutional ethical committee clearance and appropriate informed concerned.Results: Among 98 children with hypertension; 30 had hypertensive emergency. Incidence was 0.3%. Intrinsic renal and renal vascular causes were the commonest. Headache, dizziness and vomiting were the comment presentation. Half of them had encephalopathy. Younger children had more of secondary HTN and in children (older than 7 years) primary hypertension increased as did family history of hypertension.Conclusions: With increasing primary hypertension among older children, hypertensive emergencies are increasing. As most of the children with HTN are asymptomatic; detection of target organ damage is vital.

Prognostic Value of Fibrinogen/HDL Ratio in Idiopathic Sudden Sensorineural Hearing Loss.

Vascular causes are most frequently implicated in idiopathic sudden sensorineural hearing loss (ISSHL), and the process has been reported to be associated with fibrinogens and plasma lipoproteins. The purpose of this study was to determine the relationship between serum fibrinogen and high-density lipoprotein (HDL) levels, and the ratios of fibrinogen/HDL and monocyte/HDL, and ISSHL. The present retrospective study included 116 patients with ISSHL. Treatment outcomes was categorised four groups according to Siegel's criteria as follows: complete recovery (Group1), partial recovery (Group 2), slight recovery (Group 3), or no improvement (Group 4). Fibrinogen, HDL and monocyte levels of patients were assessed through routine blood analyses, and fibrinogen/HDL and monocyte/HDL ratios were calculated for each patient. Fibrinogen values were significantly lower in Group 1 than in Groups 3 and 4, whereas the values were also significantly lower in Group 2 than in Group 3. HDL values in Group 1 were significantly higher than in the other groups. Fibrinogen/HDL values were significantly lower in Group 1 than in Groups 3 and 4. However, there was no significant difference among the groups with regard to monocyte/HDL ratios. To our knowledge, this is the first study investigating the fibrinogen/HDL ratio in ISSHL in the literature. Although fibrinogen/HDL ratio might be a useful prognostic indicator for hearing recovery in patients with ISSHL, further studies with a larger patient population is required to confirm its clinical practicability and reliability.

English

BACKGROUND The sellar and juxtasellar region is a complex area where varied pathologies can occur. Differentiation among various pathologies may not always be easy, since many of these lesions mimic pituitary adenomas on clinical presentation, endocrinologic and radiologic examinations. The study intends to describe the imaging characteristics of the spectrum of pathological conditions affecting these regions using magnetic resonance imaging (MRI). METHODS The main source of data for the study were patients from hospitals attached to Bangalore Medical College and Research Institute, Bengaluru viz. Victoria Hospital, Bowring and Lady Curzon Hospital and Vani Vilas Hospital. Patients with suspected sellar and juxtasellar pathology on clinical examination referred to the Department of Radiodiagnosis from November 2017 to May 2019 underwent MRI study using Siemens 1.5-T Magnetom Avanto MR system. Magnetic resonance imaging was done in all patients according to the pituitary protocol. RESULTS Among the 50 patients, there were 16 males and 34 females. Most of the patients were in the third to fifth decade of life. The various abnormalities on MRI included neoplastic (68 %), malformative (8 %), vascular (6 %), granulomatous, infectious and inflammatory (18 %) lesions. Pituitary adenomas (46 %) were the most common lesions in sellar and juxtasellar regions, followed by tuberculosis (10 %), craniopharyngioma (8 %), Rathke's cleft cyst (6 %), meningioma (6 %), internal carotid artery (ICA) aneurysm (4 %), epidermoid (2 %) and miscellaneous lesions. CONCLUSIONS MR imaging characteristics were sufficiently distinct to allow various sellar and juxtasellar pathologies to be differentiated from each other. The spectrum of MRI findings were related to neoplastic, malformative, infectious, inflammatory, granulomatous and vascular causes. Our study observed that MRI with appropriate imaging protocols is the essential imaging modality in evaluation of sellar and juxtasellar lesions. KEYWORDS Pituitary, Sellar, Juxtasellar, Magnetic Resonance Imaging

POS-784 VESICO-URETERAL REFLUX POST RENAL TRANSPLANTATION,A DESCRIPTIVE STUDY

The vesico-ureteral reflux (VUR) is a urological complication frequently encountered in post renal transplantation (RT), reaching 10 to 15% in some series. The objective of our study is to determine the prevalence of VUR after RT, to study the characteristics of the affected population and the impact on graft function. A retrospective descriptive study of all kidney transplant patients between 2007 and 2018 who were diagnosed with a VUR after RT. The characteristics of the initial nephropathy, the mode of revealing of the reflux, the consequences on renal function and the recurrence of urinary tract infections were studied for each . Among the 209 kidney transplants, 31 patients had a RVU, making it a prevalence of 14,8 %, with a sex ratio of 1,58 : 19 men and 12 women. The mean age at the time of transplantation was 28,33 years old. For initial nephropathy, 22 had chronic interstitial nephropathy (71%) including 8 secondary to reflux nephropathy, 19,4% had a glomerular desease and 3,2 % had a vascular cause. Before transplantation, patients had an average hemodialysis duration of 2.6 years with extremes ranging from a few months to 10 years, 13 patients were already oligo-anuric. As for VUR on graft, it was diagnosed with an average delay of 11.5 months post TR [3 months;36months] in front of recurrent urinary tract infections in 10 patients, pyelocalicial dilation seen on renal ultrasound in 4 cases and unexplained creatinine increase in 6 cases. VUR on renal graft is seen in patients of different sex and age with a variable duration of hemodialysis and residual diuresis, but in post-transplantation, it is the recurrence of urinary tract infections that should make the diagnosis suspected.

Tinnitus, Hyperacusis, Otalgia, and Hearing Loss.

This article reviews the causes of tinnitus, hyperacusis, and otalgia, as well as hearing loss relevant for clinicians in the field of neurology. Important causes of unilateral and bilateral tinnitus are discussed, including those that are treatable or caused by serious structural or vascular causes. Concepts of hyperacusis and misophonia are covered, along with various types of neurologic disorders that can lead to pain in the ear. Hearing loss is common but not always purely otologic. Tinnitus and hearing loss are common symptoms that are sometimes related to a primary neurologic disorder. This review, tailored to neurologists who care for patients who may be referred to or encountered in neurology practice, provides information on hearing disorders, how to recognize when a neurologic process may be involved, and when to refer to otolaryngology or other specialists.

Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults: A Narrative Review.

The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comprehensive list of rare anatomical variations and malformations causing median nerve compression. A total of 62 studies describing median nerve compression due to an anatomical structure in adults published from 2000 in English were included. The findings were: 35 tenomuscular, 16 vascular causes, and 4 cases with nerve involvement. Only 1 osseous and 18 combined anomalies caused compression. In 18 cases, the anomaly was found in the proximal forearm. In 44 cases, the median nerve was surgical released and 35 anomalies were completely resected. Persistent or recurrent symptoms were present in 13 cases. During follow-up, 1 case of recurrence was reported.Standard operative option for median nerve compression consists of an open median nerve release. In case of persistent or recurrent carpal tunnel syndrome, unilateral symptoms, the presence of a palpable mass, manifestation of symptoms at young age and pain in the forearm or upper arm, the surgeon has to rule out the presence of an anatomical anomaly. Complete resection of the anomaly is not always necessary. The surgeon should be aware of potential anomalies to avoid inadvertent damage at surgery.

Usefulness of orbital colour Doppler ultrasound in vascular-related monocular vision loss.

Acute, painless, monocular vision loss (APMVL) usually has a vascular aetiology. We conducted a prospective observational study from 2011 to 2018 to analyse the added value of colour Doppler imaging to assess orbital vessel blood flow in the diagnosis of APMVL. The study included 67 patients (39 [58.2%] men; mean age, 65.9 years [SD 13.7]) with APMVL evaluated at the Neurosonology Laboratory within the first 5 days of symptom onset, who were classified as having either transient or persistent monocular blindness. The blood flow in the ophthalmic and central retinal arteries was assessed using colour Doppler ultrasound with a linear 7.5-MHz transducer. Thirty-three (49.3%) patients presented transient monocular blindness, with reduced blood flow in either the ophthalmic or central retinal artery. The group with persistent vision loss included 24 cases of central retinal artery occlusion (CRAO) and 10 cases of ischaemic optic neuropathy (35.8% and 14.9%, respectively, of the total sample). These patients were older and had a higher prevalence of hypertension and mild carotid atherosclerosis. Orbital colour Doppler ultrasound (OCDUS) clarified the mechanism/cause of the ischaemia in 11 (16.4%) patients and showed abnormal flow in 46 (68.7%) patients, confirming the vascular origin in 19 (57.6%) of the transient monocular blindness cases. Lower peak systolic velocity was observed in patients with CRAO (p < 0.001), and a velocity < 10 cm/s in the central retinal artery was independently associated with the diagnosis of CRAO. OCDUS can be helpful in confirming the vascular cause and identifying the aetiology of APMVL.

Effects of Handrail and Cane Support on Energy Cost of Walking in People With Different Levels and Causes of Lower Limb Amputation

ObjectiveThe energy cost of walking with a lower limb prosthesis is higher than able-bodied walking and depends on both cause and level of amputation. This increase might partly be related to problems with balance control. In this study we investigated to what extent energy cost can be reduced by providing support through a handrail or cane and how this depends on level and cause of amputation. DesignQuasi-experimental study. SettingRehabilitation gait laboratory. ParticipantsTwenty-six people with a lower limb amputation were included: 9 with vascular and 17 with nonvascular causes, 16 at transtibial, and 10 at transfemoral or knee disarticulation level (N=26). InterventionsParticipants walked on a treadmill with and without handrail support and overground with and without a cane. Main Outcome MeasuresEnergy cost was assessed using respirometry. ResultsOn the treadmill, handrail support resulted in a 6% reduction in energy cost on average. This effect was attributed to an 11% reduction in those with an amputation attributable to vascular causes, whereas the nonvascular group did not show a significant difference. No interaction with level of amputation was found. Overground, no main effect of cane support was found, although an interaction effect with cause of amputation demonstrated a small nonsignificant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the nonvascular group when walking with a cane. The effect of support was positively correlated with self-selected walking speed. ConclusionsThis study demonstrates that providing external support can contribute to a reduction in energy cost in people with an amputation due to vascular causes with reduced walking ability while walking in the more challenging condition of the treadmill. Although it is speculated that this effect might be related to problems with balance control, this will need further investigation.