Vascular Irregularity Research Articles

Evaluation of vascular invasion in pancreatic head tumors and its impact on radical surgical treatment

Objective. To evaluate the informativeness and sensitivity of radiological criteria for vascular invasion in pancreatic head tumors in comparison with intraoperative data and results of routine pathological examination. Materials and methods. The study included 98 patients with ductal adenocarcinoma of the pancreatic head with suspected venous invasion and spread of tumor growth along the vessels of the portomesenteric axis, who were operated on at the Department of Pancreatic and Bile Duct Surgery of the National Research Center of Surgery and Transplantation named after O. A. Shalimov in the period from 2019 to 2023. Group 1 included 51 (52.0%) patients who underwent radical surgery with resection of the superior mesenteric/hepatic portal vein and extended lymph and neurodissection, and group 2 included 47 (48.0%) patients who had positive vascular margins of pancreatic resection according to routine pathological examination. Diagnostic criteria for vascular alterations were developed. A comparative analysis of the informativeness of the developed criteria and the results of a routine pathological examination was performed. The edges of the pancreatic resection were evaluated, including the neck of the gland, common bile duct, duodenum/gastric duct, and the bed of the superior mesenteric/hepatic portal vein and superior mesenteric artery separately. R1 status was defined as the presence of tumor cells at a distance of less than 1 mm to the resection margin. Results. According to the criteria of the National Comprehensive Cancer Network (NCCN) 2023.2, 61 (62.2%) patients had a marginally resectable stage of ductal adenocarcinoma of the pancreatic head and tumor contact with the superior mesenteric/hepatic veins according to multislice computed tomography of the abdominal cavity. In group 1, there were 36 (70.6%) such patients, in group 2 – 25 (53.2%). According to the proposed radiologic criteria for vascular invasion, tumor contact with the superior mesenteric/hepatic portal veins was suspected in 76 (77.6%) patients, which is higher than in the standard approach. Determination of vascular alterations according to the results of our study is a more reliable method for diagnosing invasion of the superior mesenteric/hepatic portal vein (χ2 = 5.46, p = 0.019) and predicting the performance of radical surgery, including vascular resection. Conclusions. The proposed criteria for the radiological diagnosis of vascular invasion at the preoperative stage increased the sensitivity of this method from 62.2 to 77.6%. The most frequent radiological signs of vascular alteration are vascular wall irregularity (47.7%) and parapancreatic tissue density (62.5%). In the presence of any of the radiological signs of vascular alteration, resection of the affected area of the superior mesenteric/hepatic portal vein with extended lymph and neurodissection is indicated, which allows a statistically significant increase in the number of R0 resections.

The Clinical Outcome of Carotid Blowout Syndrome Showing Non-bleeding Angiography.

Patient with carotid blowout syndrome (CBS) may demonstrated non-bleeding digital subtraction angiography (DSA) without identifying pseudoaneurysm or contrast extravasation. Our objective is to evaluate the clinical outcomes for this specific subset of patients. A retrospective observational study was conducted on 172 CBS patients who received DSA for evaluation of transarterial embolization (TAE) between 2005 and 2022, of whom 19 patients had non-bleeding DSA and did not undergo TAE. The age (55.2 ± 7.3 vs.54.8 ± 11.1), male sex (17/19 vs. 135/153), tumor size (5.6 ± 2.4 vs. 5.2 ± 2.2), cancer locations were similar (P > 0.05) between both groups; except for there were more pseudoaneurysm/active bleeding (85.6% vs.0%) and lessvascular irregularity (14.4% vs. 94.7%) in the TAE group (P < 0.001). In the multivariable Cox regression model adjusting for age, sex, and tumor size, non-bleeding DSA group was independently associated with recurrent bleeding compared to TAE group (adjusted hazard ratio = 3.5, 95% confidence interval: 1.9-6.4, P < 0.001). Furthermore, the presence of vascular irregularity was associated with segmental recurrent bleeding (adjusted HR = 8.0, 95% CI 2.7-23.3, P < 0.001). Patient showing non-bleeding DSA thus not having TAE had higher risk of recurrent bleeding, compared to patient who received TAE. Level of Evidence Level 4, Case Series.

Effect of TiO2 Microparticles in Lettuce (Lactuca sativa L.) Seeds and Seedlings.

The particle size reduction technology is used in several segments, including sunscreens and new techniques and product improvement. One of the main particles used in the sunscreens formulation is titanium dioxide (TiO2). This formulation allows for better characteristics of these products. Perspectives like incorporation of the particles by other biological systems beyond humans and their effects should be observed. This work aimed to evaluate the titanium dioxide microparticles phytotoxicity on Lactuca sativa L. plants through tests of germination, growth, and weight analysis using microscopy techniques: optical microscopy (OM) and scanning electron microscopy (SEM). Some of the results showed cellular and morphological damage, mainly in the roots and 50mgL-1 TiO2 concentration, confirmed by SEM. Additionally, anatomical damages like vascular bundle disruption and irregularity in the cortex cells were confirmed by SEM. Additionally, anatomical damages were observed on the three main organs (root, hypocotyl, and leaves) evidenced by the OM. Perspectives to confirm new hypotheses of the interaction of nanomaterials with biological systems are necessary.

A new imaging sign in COVID-19 pneumonia: vascular changes and their correlation with clinical severity of the disease.

It has come to our attention that specific vascular changes (VCs) appear more frequently in chest computed tomography (CT) of patients with coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate if these specific VCs in chest CT correlate with clinical severity of the disease. CT images of 102 patients who underwent low-dose noncontrast chest CT due to COVID-19 between 11 March 2020 and 11 April 2020 were evaluated retrospectively. The patients were divided into two groups based on the presence of VCs in CT images. VCs in chest CT of patients with COVID-19 were defined using the following descriptors: decreased lumen caliber, vascular wall irregularity, angulation in the course of the vessel, vascular disruption, and/or interruption. The relationship of these VCs with disease symptoms (fever, cough, shortness of breath), comorbid conditions (diabetes, hypertension, asthma), smoking habit, disease-specific laboratory changes (white blood cell-lymphocyte count, neutrophil/lymphocyte ratio, C-reactive protein [CRP], D-dimer, lactate dehydrogenase [LDH], ferritin, procalcitonin), lung parenchymal infiltration pattern (ground-glass opacity, crazy-paving pattern, consolidation) and its distribution (peripheral, central, mixed, upper lobes, lower lobes, right middle lobe) on CT were investigated by comparison of these variables between patients with and without VCs in chest CT. VCs were observed in 18 out of 102 patients (18%) with typical parenchymal involvement for COVID-19. There was no significant difference in terms of age and sex. We found an irregularity in the wall of the vascular structures in the distal branches and decreased lumen caliber of the vessels related to ground-glass opacities in 15 patients, concentric luminal narrowing in annular form in 4 patients, angulation/traction or springiness in the vascular structures towards the active lesions in 3 patients, and interruptions along the vascular course in 1 patient. VCs were significantly correlated with fever (12/18, 66.7%) and shortness of breath (7/18, 39%). These changes were significantly more remarkable in common disease involving both upper and lower lobes (10/18, 56%). In these cases, there was a substantial increase in CRP (15/18, 83%; mean, 5.7±6.3 mg/dL) and LDH (8/18, 44%) values compared to those who did not have any VCs. The results of this study suggest that specific VCs observed in chest CT may predict the disease severity in cases of COVID-19 pneumonia. These changes may be related to respiratory distress in the disease.

Ultrasonography is insensitive but specific for detecting aortic wall abnormalities in dogs infected with Spirocerca lupi

BackgroundSpirocercosis is caused by the nematode Spirocerca lupi (S lupi). The disease mainly affects dogs and is typically diagnosed by oesophagoscopy or faecal examination; however, these diagnostic tests may deliver...

Cholangioscopy in diagnosis of diseases of extrahepatic bile ducts

An analysis of the diagnosis of extrahepatic bile duct diseases in 115 patients is presented. With the diagnostic purpose they performed ERCP, EPT, cholangioscopy. The method of direct visualization of the mucous membrane of the bile ducts allows you to identify endoscopic signs of strictures. Differential diagnosis of benign and malignant strictures of the bile ducts using cholangioscopy is difficult. Nevertheless, we were able to identify some typical signs for malignant strictures, including ulceration and mucosal infiltration, vascular pattern irregularity, stricture asymmetry.

Complement Factor H Mutation W1206R Causes Retinal Thrombosis and Ischemic Retinopathy in Mice

Single-nucleotide polymorphisms and rare mutations in factor H (FH; official name, CFH) are associated with age-related macular degeneration and atypical hemolytic uremic syndrome, a form of thrombotic microangiopathy. Mice with the FH W1206R mutation (FHR/R) share features with human atypical hemolytic uremic syndrome. Herein, we report that FHR/R mice exhibited retinal vascular occlusion and ischemia. Retinal fluorescein angiography demonstrated delayed perfusion and vascular leakage in FHR/R mice. Optical coherence tomography imaging of FHR/R mice showed retinal degeneration, edema, and detachment. Histologic analysis of FHR/R mice revealed retinal thinning, vessel occlusion, as well as degeneration of photoreceptors and retinal pigment epithelium. Immunofluorescence showed albumin leakage from blood vessels into the neural retina, and electron microscopy demonstrated vascular endothelial cell irregularity with narrowing of retinal and choroidal vessels. Knockout of C6, a component of the membrane attack complex, prevented the aforementioned retinal phenotype in FHR/R mice, consistent with membrane attack complex-mediated pathogenesis. Pharmacologic blockade of C5 also rescued retinas of FHR/R mice. This FHR/R mouse strain represents a model for retinal vascular occlusive disorders and ischemic retinopathy. The results suggest complement dysregulation can contribute to retinal vascular occlusion and that an anti-C5 antibody might be helpful for C5-mediated thrombotic retinal diseases.

Multicenter prospective study on the histological diagnosis of gastric cancer by narrow band imaging-magnified endoscopy with and without acetic acid.

Background and study aims The usefulness of endoscopy for diagnosing histological type remains unclear. This study aimed to examine the diagnostic accuracy of white light endoscopy (WLE), magnified endoscopy with narrow band imaging (NBI-ME), and NBI-ME with acetic acid enhancement (NBI-AA) for histological type of gastric cancer. Patients and methods Patients with depressed-type gastric cancers resected by endoscopic submucosal dissection were prospectively enrolled, and 221 cases were analyzed. Histological type was diagnosed by WLE, followed by NBI-ME and NBI-AA. Histological type was classified into differentiated adenocarcinoma and undifferentiated adenocarcinoma. Histological type was diagnosed based on lesion color in WLE, surface patterns (pit, villi, and unclear) and vascular irregularities in NBI-ME, and surface patterns in NBI-AA. Results Histological types of target areas were differentiated adenocarcinoma and undifferentiated adenocarcinoma in 206 and 15 cases, respectively. Diagnostic accuracy of WLE, NBI-ME, and NBI-AA for the histological type was 96.4 % (213/221), 96.8 % (214/221), and 95.5 % (211/221), respectively. No significant differences were observed among modalities. Positive predictive value based on endoscopic findings in NBI-ME was 98.0 % (149/152) for the villi pattern, 100 % (19/19) for the irregular pit pattern, 100 % (9/9) for the unclear surface pattern with a vascular network, 90.3 % (28/31) for the unclear surface pattern with mild vascular irregularity, and 88.9 % (8/9) for the unclear surface pattern with severe vascular irregularity. Conclusions NBI-ME and NBI-AA did not show any advantages over WLE for diagnostic accuracy. Villi pattern, irregular pit pattern, and vascular network may be useful for identifying differentiated adenocarcinoma.

Prevalence of Sonographic Markers of Placenta Accreta Spectrum in Low-Risk Pregnancies.

This study was aimed to evaluate the prevalence of sonographic markers for placenta accreta spectrum (PAS) in pregnancies at low-risk for PAS. Pregnant women at low-risk for PAS presenting for routine second trimester ultrasound who enrolled in the study were evaluated prospectively for sonographic markers of PAS during two ultrasounds at 18 to 24 and 28 to 34 weeks. Frequencies of PAS markers were compared between the second and third trimester and between those with and without prior cesarean deliveries (CD). Overall, 174 women were included. Several markers were seen frequently in the second trimester: vascular cervical invasion (57%), lacunae (46%), subplacental hypervascularity (37%), and irregularity of the posterior bladder wall (37%). Other markers were seen infrequently or not at all: loss of the retroplacental clear zone, uterovesical interface < 1 mm, bridging vessels, placental bulge or focal exophytic mass. Frequencies of markers did not differ between women with and without prior CD. Lacunae were larger and more numerous in the third trimester. Two or more PAS markers were observed in 98% of second trimester ultrasounds. Several PAS sonographic markers occur commonly in low-risk pregnancies. In the absence of risk factors, the independent predictive value of these markers is questionable.

Novel Forehead Augmentation Strategy: Forehead Depression Categorization and Calcium-Hydroxyapatite Filler Delivery after Tumescent Injection

The minimally invasive delivery of soft-tissue calcium hydroxyapatite fillers can ameliorate the appearance of forehead depressions and wrinkles. Forehead augmentations using fillers lead to fewer adverse events and to a faster recovery time than those using surgical procedures. However, many physicians avoid using them due to the risk of pain, intravascular injections, and embolisms that can cause skin necrosis and blindness. Strategy to address these issues includes pain reduction through tumescent solution before filler injection considering the vascular pathway. In addition, the strategy is also safer from embolism. The author presents a forehead augmentation technique involving the injection of a tumescent solution for tissue hydrodissection. Not only does this create a pocket of space (TS) for filler placement, it also allows the physician to detect bleeding and prevent vessel compromise It is better to minimize the number of entry-points where no vessel exists. By minimizing the number of entry-points and physical proximity to vessels and nerves during injection, this technique reduces the risks of embolization and bleeding. For optimal, patient-customized results, the author also classifies forehead depressions in 5 different categories, depending on the severity, shape, contour, slope, and quantity of volume deficiency observed. The author treated 218 patients using the author's forehead augmentations (using one central entry-site after TS test injection). The method was easy to perform and safe from adverse effects such as vascular problem, irregularity, infection, and prolonged swelling. Using this simple technique, I demonstrate how calcium hydroxyapatite fillers can be injected with little force or dilution, thus preserving its original properties while increasing procedural safety, minimizing pain, restoring convexity, and creating ideal curvatures.

Invited Commentary

Invited Commentary

Chemoembolization-induced arterial damage: Evaluation of three different chemotherapeutic protocols using epirubicin and miriplatin

We aimed to evaluate hepatic vascular changes following lipiodol-based transarterial chemoembolization of hepatocellular carcinoma using epirubicin (EPI), miriplatin (MPT) and miriplatin plus low-dose epirubicin (MPT+EPI). A total of 185 arteries in 118 patients who underwent chemoembolization using EPI (67 arteries in 48 patients), MPT (64 arteries in 37 patients) and MPT+EPI (54 arteries in 33 patients) were retrospectively examined. The maximum dose limit of MPT was 140 mg and that of EPI was 50 and 20 mg for the EPI and MPT+EPI groups, respectively. Vascular changes and local recurrence were evaluated by subsequent angiography. Factors affecting arterial damage were analyzed using multivariate logistic regression analysis. More severe arterial damage was observed in the EPI group (88.1%) than in the MPT+EPI (72.2%) and the MPT (18.7%) groups (P = 0.044 and P < 0.001, respectively). EPI usage (hazard ratio [HR] = 12.8, P < 0.001), selective chemoembolization (HR = 5.4, P < 0.001) and MPT usage (HR = 0.28, P = 0.020) were significant predictors for arterial damage induction. The local recurrence rate was lower for the lesions exhibiting arterial occlusion after chemoembolization (39.4%) than for the lesions exhibiting no vascular attenuation (73.9%) or wall irregularity (75.8%) (P = 0.001 and P = 0.005, respectively). High-dose EPI, MPT, and low-dose EPI plus MPT usage in chemoembolization for hepatocellular carcinoma induced the greatest, the least, and intermediate vascular damages, respectively. Therapeutic occlusion of tumor feeder vessels is associated with lower local recurrence.

Alterations in the vascular architecture of the dorsal root ganglia in a rat neuropathic pain model

An alteration in the structural arrangement of blood vessels identified by RECA immunohistochemistry was studied in a rat L4 dorsal root ganglia (L4-DRG) neuropathic pain model. We compared a three-dimensional (3-D) reconstruction of the vascular architecture surrounding bodies of the primary sensory neurons in the L4-DRG of naïve rats with that of rats that had surgically undergone unilateral sciatic nerve ligature. Rhodamine-conjugated dextran (Fluoro-Ruby) was used for retrograde labelling of neurons, the axons of which had been injured by nerve ligature. In contrast to DRG from naïve rats and contralateral DRG from operated rats, an increased proportion of RECA+ vascular area and the appearance of nest-like arrangements of blood vessels around neuronal bodies with injured axons were observed in L4-DRG ipsilateral to the sciatic nerve ligature. Fractal analysis confirmed a higher degree of vascular branching, irregularity, and tortuosity in L4-DRG related with sciatic nerve injury. The results suggest that nerve injury induces changes in vascular architecture in associated DRG.

Prospective Study of Prostate Tumor Angiogenesis and Cancer-Specific Mortality in the Health Professionals Follow-Up Study

Tumor growth requires the development of independent vascular networks that are often primitive in morphology and function. We examined whether microvessel morphology contributes to the considerable biologic heterogeneity of prostate cancer. We evaluated microvessel morphology as a predictor of prostate cancer mortality among 572 men in the Health Professionals Follow-Up Study diagnosed with cancer during 1986 to 2000. We immunostained prostatectomy tumor block sections for endothelial marker CD34 and assessed microvessel density, vessel size (area and diameter), and irregularity of vessel lumen using image analysis. Proportional hazards models were used to assess microvessel density and morphology in relation to lethal prostate cancer. Poorly differentiated tumors exhibited greater microvessel density, greater irregularity of the vessel lumen, and smaller vessels. During 20 years of follow-up, 44 men developed bone metastases or died of cancer. Men with tumors exhibiting the smallest vessel diameter, based on quartiles, were 6.0 times more likely (95% CI, 1.8 to 20.0) to develop lethal prostate cancer. Men with the most irregularly shaped vessels were 17.1 times more likely (95% CI, 2.3 to 128) to develop lethal disease. Adjusting for Gleason grade and prostate-specific antigen levels did not qualitatively change the results. Microvessel density was not linked to cancer-specific mortality after adjusting for clinical factors. Aggressive tumors form vessels that are primitive in morphology and function, with consequences for metastases. Vascular size and irregularity reflect the angiogenic potential of prostate cancer and may serve as biomarkers to predict prostate cancer mortality several years after diagnosis.

RUPTURED PROXIMAL LENTICULOSTRIATE ARTERY FUSIFORM ANEURYSM PRESENTING WITH SUBARACHNOID HEMORRHAGE

Lenticulostriate artery aneurysms are rare. When present, distal locations in and around the basal ganglia are more common and often present with intraparenchymal hemorrhage when ruptured. We present a very rare case of a ruptured proximal lenticulostriate fusiform aneurysm presenting with subarachnoid hemorrhage. We report the case of a 31-year-old healthy man who presented after the sudden onset of headache, nausea, and lethargy without neurological deficits. Cranial computed tomographic scanning demonstrated diffuse subarachnoid hemorrhage, and a cranial computed tomographic angiogram demonstrated a vascular irregularity on the superior surface of the left distal M1 trunk of the middle cerebral artery. A cerebral angiogram demonstrated a left proximal lenticulostriate fusiform aneurysm without evidence of moyamoya-like vessels or vasculitis. No other pathology or infectious etiology was noted. Endovascular therapy was deemed unsafe, and microsurgical exploration and intervention was the more favorable and safe approach. A standard left pterional craniotomy was performed and the afferent lenticulostriate vessel into the fusiform aneurysm was visualized. Temporary clips were applied to the proximal and distal M1 trunk and miniclips were applied across the afferent portion and fundus of the aneurysm, thus sacrificing the parent lenticulostriate artery. A postoperative computed tomographic scan demonstrated an area of hypodensity in the left basal ganglia. The patient's postoperative right facial and upper extremity weakness improved to normal several days after aneurysmal clipping. This is the first report of a ruptured proximal lenticulostriate artery fusiform aneurysm, which presented as subarachnoid hemorrhage in a healthy patient without an underlying vascular disease.

NODE DEGREE DISTRIBUTION IN COMPLEX MICROVASCULAR NETWORKS: A POTENTIAL NEW DIAGNOSTIC TOOL FOR EXTRACELLULAR MATRIX-RELATED DISEASES

Recent research indicates the presence of increased vascular density and irregularity on oral mucosal vascular networks in extracellular matrix (ECM)-related illness or conditions. Here, we estimated the frequency of occurrence of nodes of various degrees (K3, K4 and K5, where Kn designates a node with n connections) in patients with proven or suspected ECM-related conditions and in controls. Subjects with ECM-related conditions exhibited lower K3 and higher K4 frequency than controls (p &lt; 0.0001) in their vascular networks. Inverse statistical correlations between the local fractal dimension and L-Z values and percentage of K3 (Pearson's r values range: -0.91 to -0.81; p values range: 0.0013 to &lt; 0.0001), together with a positive relationship with K4 were observed (r values range: 0.81 to 0.86; p values range: 0.0015 to 0.0003). A positive correlation coefficient between D(1–46) and K5 frequency was also found (r = 0.6334, p = 0.027). K3 ≥ 52% or K4 &lt;28% discriminated ECM patients from controls with 100% sensitivity (true positive cases to true positive + false negative ratio) and specificity (true negative cases to true negative + false positive ratio). These findings suggest that node degree distribution in oral vascular networks could be a helpful new marker of pathological conditions associated with proven or suspected ECM abnormalities.

Vascular atypia and irregularity on surface as signs of malignant adnexal mass: A complementary method of laparoscopic assessment

Study objective To evaluate the risk of malignancy associated with the main macroscopic findings observed on adnexal masses during a laparoscopic approach. Design Prospective series of consecutive patients (Canadian Task Force classification II-2). Setting Tertiary care university hospital. Patients One hundred fifteen patients were included. Ninety-eight had benign and 17 malignant adnexal masses. Interventions Diagnostic and operative laparoscopy. Measurements and main results Adnexal images were obtained during laparoscopy, recorded, and analyzed according to irregularity on surface, presence of atypical vessels, lobular form, absence of coral-like surface, implants, large-volume ascites, and cloudy or hemorrhagic ascites. A logistic regression was applied, and the independent findings associated with malignant disease were atypical vessels (OR 16.37; 95% CI 2.85–94.13; p <.01) and irregularity on tumor surface (OR 43.41; 95% CI 8.02–234.96; p <.05). In this way, 95% of the cases were correctly diagnosed. Conclusions Atypical vessels and irregularity on tumor surface were important criteria of malignancy during laparoscopic treatment of adnexal masses. The recognition of these features can be helpful in choosing the ideal surgical approach mainly when the preoperative evaluation is unsatisfactory.

Power Doppler Ultrasonografy (Pdu) as an Additional Tool to Increase Reliability of Systematic Biopsy of the Prostate

Diagnosis of prostate cancer has until recently relied primarily on eight core TR biopsy. Tests are being carried out to verify whether PDU can effectively aid such diagnosis thereby reducing the number of biopsies and tissue samplings. This has also been our attempt. Two groups of patients were examined for increased PSA with or without a palpable prostatic nodule. The first group was composed by 52 patients between 55 and 83 years of age (av. 69.57) with PSA values between 0.87 and 94.91 ng/mL (r.8.085) of which 29 (55.75%) showed a palpable nodule. All patients underwent prostatic eight core TR ecobiopsy. The second group was composed by 56 patients between 49 and 84 years of age (av.69.19) with PSA values between 1.14 and 59.7ng/mL (r.8.74) of which 33 (58.97%) showed a palpable nodule. This group of patients underwent a PDU just before TR biopsy in order to assess prostatic blood supply and locate possible alterations. Prostatic volume in both groups was never higher than 50 cc. Of the first group 25 patients (48.08%) were prostate cancer positive. Of the second group 31 patients (55.36%) were positive to a biopsy for prostate cancer. In addition 22 out of the 31 showed a vascular irregularity. From the evidence above (tests carried out by the same operator with two homogeneous groups of patients-Wilcoxon test-) it is clear that PDU usefully worked in diagnosing a higher number of prostate cancers. Diagnostic sensitivity and specificity was markedly increased by the association of PDU and TR biopsy.

Thoughts evoked by MATCH and other trials.

Many different processes are involved in platelet activation. Most drugs affect one of these chemical reactions. Theoretically, platelet functions (secretion, aggregation, and adhesion) can be reduced most effectively by using >1 agent or by inhibiting the final step in the attachment of the platelet to fibrin at the level of the glycoprotein IIb/IIIa (GpIIb/IIIa) receptor. Preliminary experience with oral and intravenous GpIIb/IIIa inhibitors has shown that bleeding is an important problem. In MATCH, 2 platelet function inhibitors, clopidogrel and aspirin, did prevent slightly more strokes (but not with statistical significance) but at the price of significantly more excess bleeding. Killing platelets causes bleeding. Platelets seem to swim happily in the blood until they reach an area of irregular or damaged endothelium, for example, on the surface of an ulcerated atherosclerotic plaque in a large artery. They then stick to that irregular surface and to each other in an attempt to heal the vascular irregularity. The white platelet–fibrin thrombus can break loose and embolize. The platelet plug also activates the coagulation cascade, promoting the formation of a red erythrocyte–fibrin-rich clot. Perhaps rather than killing the platelet, it might be better to inhibit platelet attachment to the endothelium. Antiplatelet drugs might do this but have not been tested thoroughly for their effect on endothelial–platelet interaction. Theoretically, antiplatelet agents should work by inhibiting formation of white clots. These tend to form on irregular …

Dose hysteroscopic observation of vascular irregularity improves upon the diagnostic sensitivity to atypical endometrial hyperplasia?

Dose hysteroscopic observation of vascular irregularity improves upon the diagnostic sensitivity to atypical endometrial hyperplasia?