Abnormal Wall Research Articles

Ultrasound Guided Supraclavicular Block in Poland Syndrome : A Safe Alternative to General Anaesthesia

Poland syndrome is an uncommon, congenital anomaly characterized by multiple systems and organs involvement like musculoskeletal, lungs, heart, kidneys and haemopoetic system with absence of functional disability. Right sided Thorax deformity is the most common feature of this syndrome with the absence of underlying bones and muscles making this condition similar to open chest along with ipsilateral hand anomalies such as brachydactyly, syndactyly or ectodactyly [1]. The incidence of this syndrome is 1 per 30,000-50,000 live births [2]. Patients with Poland syndrome require anesthesia during surgical procedures to correct the associated deformities or the organ systems associated with the disease process. Literature shows that these patients may be more susceptible for malignant hyperthermia due to associated musculoskeletal abnormalities under general anesthesia [3]. Moreover respiratory problems and hypoxia in the perioperative period may be related to associated paradoxical breathing, lung hypoplasia and chest wall abnormalities in otherwise asymptomatic patient at rest. We report a diagnosed case of Poland syndrome presented for syndactly release Keywords: USG blocks, Supraclavicular approach.

Cause of Ascending Aortic Dilatation in Patients with Bicuspid Aortic Valves: The Final Link.

This article discusses about the cause of dilatation of the ascending aorta in patients with congenitally bicuspid aortic valves (CBAVs). Some members of the profession believe that it is genetic, while others attribute it to turbulence. The author previously presented in vitro data proving that CBAVs are inherently morphological stenotic, even in the absence of measurable gradient and clinical symptoms. This article reinforces the view that the dilatation of the ascending aorta in patients with CBAV represents a "poststenotic dilatation" by demonstrating that the structure of the aortic wall is normal in infants who have CBAV as a sole cardiac anomaly. The aortic wall was studied in newborns who had CBAV as the sole cardiovascular anomaly and in those where CABV was associated with other inborn cardiovascular defects. We found that in patients where CBAV is the sole cardiovascular anomaly, aortic structure is normal at birth, but abnormal if additional cardiovascular anomalies are present. Dilatation of the ascending aorta in patients, where CBAV is the only cardiovascular anomaly, is caused by turbulence (poststenotic dilatation). If additional cardiovascular anomalies are present, this process may be exaggerated by genetic abnormalities of the aortic wall.

Abstract 16999: Effect of Positional Echocardiogram on Right Sided Hemodynamics in Pectus Excavatum Patients vs. Healthy Adults

Introduction: Pectus excavatum (PE) is the most common anterior chest wall deformity with dorsal deviation into the thoracic cavity. Depending on the severity, PE can cause minor cosmetic problem to significant cardiac compression in severe cases. This compression most frequently affects right heart chambers causing symptoms such as dyspnea, palpitations, fatigue, exercise intolerance, and difficulty with keeping up with peers. Previously, we reported the change in these symptoms with positon associated with change in right heart hemodynamics. Further, we are comparing the changes in right heart hemodynamics with position in pectus patients to normal healthy adults. Methods: A prospective cohort of 40 pectus excavatum patients (mean Haller index: 5.4±2) undergoing evaluation at Mayo clinic underwent 2-D transthoracic echo (TTE) with Doppler assessment of Right Ventricular Outflow Tract (RVOT) Velocity Time Integral (VTI). A cohort of 8 healthy adults without chest wall abnormality who had clinically indicated echocardiogram was used as control (Table). Additional assessment of the RVOT VTI was performed in sitting position in either group. A two-sample t-test was performed to assess significance between cohorts. Results: There is a significant difference in RVOT VTI between case and control cohorts in both supine and sitting positions (p=0.03 & p=0.001 respectively). Also, there is a significant decrease in RVOT VTI from supine to sitting position in PE patients compared to healthy adults (Table). Conclusion: This is the 1 st prospective cohort study in PE patients vs healthy adults showing the feasibility and utility of dynamic echocardiography in assessing the right ventricular hemodynamics. This study demonstrates a significant decrease in right sided hemodynamic changes with change in position in patients with PE which might explain their symptoms.

The prothrombotic state in atrial fibrillation: pathophysiological and management implications.

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia and is associated with significant morbidity and mortality. There is plenty of evidence available to support the presence of a prothrombotic or hypercoagulable state in AF, but the contributory factors are multifactorial and cannot simply be explained by blood stasis. Abnormal changes in atrial wall (anatomical and structural, as 'vessel wall abnormalities'), the presence of spontaneous echo contrast to signify abnormal changes in flow and stasis ('flow abnormalities'), and abnormal changes in coagulation, platelet, and other pathophysiologic pathways ('abnormalities of blood constituents') are well documented in AF. The presence of these components therefore fulfils Virchow's triad for thrombogenesis. In this review, we present an overview of the established and professed pathophysiological mechanisms for thrombogenesis in AF and its management implications.

Takayasu Arteritis.

Takayasu arteritis is an idiopathic granulomatous vasculitis of the aorta and its main branches and it constitutes one of the more common vasculitides in children. Inflammation and intimal proliferation lead to wall thickening, stenotic or occlusive lesions, and thrombosis, while destruction of the elastica and muscularis layers originates aneurysms and dissection. Carotid artery tenderness, claudication, ocular disturbances, central nervous system abnormalities, and weakening of pulses are the most frequent clinical features. The diagnosis is usually confirmed by the observation of large vessel wall abnormalities: stenosis, aneurysms, occlusion, and evidence of increased collateral circulation in angiography, MRA or CTA imaging. The purpose of this revision is to address the current knowledge on pathogenesis, investigations, classification, outcome measures and management, and to emphasize the need for timely diagnosis, effective therapeutic intervention, and close monitoring of this severe condition.

Are all incidental gallbladder cancers truly incidental? Or, are some missed cancers?

Incidental gallbladder carcinoma (IGBC) is an incidental finding of cancer on histopathological examination (HPE) of gall bladder specimen removed for benign gall bladder diseases. The incidence of IGBC ranges from 0.19–3.3%. However, many such tumours are of advanced T stage on HPE. Some of these tumors are possibly missed on either pre-operative evaluation and/or during cholecystectomy. This study was done to find the proportion of patients of IGBC who had preoperative and/or intra-operative suspicious of GBC but underwent simple cholecystectomy. Materials and methods: Data from 56 consecutive IGBC patients presented to our centre between April 2016–May 2017 was analysed. A review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect. Results: Preoperative USG was suspicious in 39% (22/56) of patients. CECT scan done in 13 of these patients confirmed gallbladder wall abnormalities in 10 cases. Majority of procedures were open cholecystectomy (39/56), suspicious intraoperative findings were documented in 15 (26.7%) patients. Time to referral after primary surgery was within one month in 30.3% (17/56), between one to two months in 35.7% (20/56), between 2 and six months in 23.3% (13/56) and after six months in 10.7% (6/56). Seventeen patients (30.3%) were advised completion surgery. Seven patients (13%) underwent completion surgery. Rest of the patients were found to be inoperable. Conclusion: Radiologists and surgeons should keep a high index of suspicion of GBC, especially in high incidence areas. Whenever, there is any suspicion, patients should be promptly referred appropriately. Even when detected incidentally, prompt referral maximises chances of curative resection.

Abstract 518: Hemodynamic Instability in Atrial Flutter With Slow Ventricular Response

Background: The commonest atrioventricular (AV) conduction ratio in atrial flutter is 2:1, with corresponding ventricular response of about 150 beats/min. Higher degree of AV block with resulting lower ventricular conduction may indicate use of AV nodal blocking drugs, intrinsic conducting system disease, electrolyte abnormalities or hypothermia. Case: An 86-year-old with history of hypertension, hyperlipidemia, hypothyroidism, coronary and carotid artery disease was admitted after a syncopal episode while on a cross country trip. He was hypotensive and profoundly bradycardic(heart rate initially in the 30s). Examination revealed irregular rhythm and right carotid bruit. EKG showed atrial flutter with variable ventricular response ranging from 3:1 to 5:1 (or more) block, with ventricular rate in the 50s and 60s. Echocardiogram showed low normal left ventricular systolic function without regional wall abnormalities, right ventricle enlargement with global systolic dysfunction, and severe left atrial enlargement. Thyroid function was normal. Decision-making: With hemodynamic instability in the setting of atrial flutter, he was started on anticoagulation and intravenous hydration, and after left atrial thrombus was ruled out with a transesophageal echocardiogram, he underwent successful urgent cardioversion. He was then noted to have intermittent Mobitz type II second degree and third degree AV block, prompting urgent temporary transvenous pacemaker (PM) placement, followed by permanent dual chamber PM implantation. He had bleeding from the PM placement site but this was controlled with pressure. Therapy with beta blocker was re-initiated, and electrolytes were supplemented as needed. Vitals signs improved and he was discharged in stable health to follow up with his cardiologist. Conclusion: Urgent or emergent cardioversion is indicated for hemodynamic instability in atrial flutter, even with slow ventricular response. In the absence of use of AV nodal blocking agents, lower rate of ventricular response may indicate intrinsic conducting system disease, and as in the case above, may require PM placement.

P1571Identification of radial vascular wall abnormalities by very-high frequency ultrasound in patients with spontaneous coronary artery dissection and fybromuscular dysplasia: the FUCHSIA study

P1571Identification of radial vascular wall abnormalities by very-high frequency ultrasound in patients with spontaneous coronary artery dissection and fybromuscular dysplasia: the FUCHSIA study

Deformidad de la caja torácica

Chest wall deformities are divided as an abnormal development during the growth or those secondary to a congenital malformation. The developmental type is the most common: pectus excavatum or pectus carinatum. The less common are the congenital types of chest wall abnormalities: Poland’s syndrome, Jeune’s syndrome, espondylothoracic dysplasia, espondylocostal dysplasia and defects of the ribs or sternum. The congenital type usually affects the relationship between the spine, rib cage and the lungs. Therefore, many of these patients will develop a progressive respiratory disturbance of restrictive type known as Thoracic Insufficiency Syndrome. Thoracic insufficiency syndrome is defining as a deficiency of the rib cage to maintain a normal respiration and to sustain the physiological growth of the lungs. In this article will discuss several conditions that will affect the development and function of the chest wall.

Aortic elasticity deterioration proves intrinsic abnormality of the ascending aorta in pediatric Turner syndrome unrelated to the aortic valve morphology

Turner syndrome (TS) is a common genetic disorder in females with high incidence of ascending aortic dilatation and even dissection occurring as early as in the second decade. Known risk factors (RF) are bicuspid aortic valves (BAV), coarctation of the aorta (CoA), and arterial hypertension. Since 10% of dissections occur in patients without RF, an intrinsic aortic wall abnormality has been postulated. This study aimed to investigate the elasticity of the ascending aorta as a surrogate marker of aortic wall texture. Forty-six pediatric patients with genetically proven TS were prospectively examined for the morphology of their aortic valve, and size and elasticity indices of the adjacent aorta. Cohorts of 46 female subjects with tricuspid aortic valves (TAV) and ten non-syndromic females with BAV were investigated as separate control groups. Comparison of healthy controls with TS patients revealed significantly deteriorated elasticity indices in those with TS. Furthermore, normalized aortic dimensions were greater in TS patients, but dilatations of the ascending aorta with z-score levels above two were restricted to those with BAV (14/46). Deteriorated elasticity indices were measured in TS patients, independent of aortic dilatation, BAV, and CoA, and were comparable to those of patients with isolated, non-syndromic BAVs. By measuring elasticity levels as a surrogate for aortic wall texture, we were able to gather evidence that TS presents with an intrinsic abnormality of the ascending aorta even in patients without concomitant BAV, CoA or dilatations as early as in childhood.

Is There a Direct Correlation Between Microvascular Wall Structure and k-Trans Values Obtained From Perfusion CT Measurements in Lymphomas?

This study aimed to test the hypothesis that ultrastructural wall abnormalities of lymphoma vessels correlate with perfusion computed tomography (PCT) kinetics. Our local institutional review board approved this prospective study. Between February 2013 and June 2016, we included 23 consecutive subjects with newly diagnosed lymphoma, who were referred for computed tomography-guided biopsy (6 women, 17 men; mean age, 60.61 ± 12.43 years; range, 28-74 years) and additionally agreed to undergo PCT of the target lymphoma tissues. PCT was obtained for 40 seconds using 80 kV, 120 mAs, 64 × 0.6-mm collimation, 6.9-cm z-axis coverage, and 26 volume measurements. Mean and maximum k-trans (mL/100 mL/min), blood flow (BF; mL/100 mL/min) and blood volume (BV) were quantified using the deconvolution and the maximum slope + Patlak calculation models. Immunohistochemical staining was performed for microvessel density quantification (vessels/m2), and electron microscopy was used to determine the presence or absence of tight junctions, endothelial fenestration, basement membrane, and pericytes, and to measure extracellular matrix thickness. Extracellular matrix thickness as well as the presence or absence of tight junctions, basal lamina, and pericytes did not correlate with computed tomography perfusion parameters. Endothelial fenestrations correlated significantly with mean BFdeconvolution (P = .047, r = 0.418) and additionally was significantly associated with higher mean BVdeconvolution (P < .005). Mean k-transPatlak correlated strongly with mean k-transdeconvolution (r = 0.939, P = .001), and both correlated with mean BFdeconvolution (P = .001, r = 0.748), max BFdeconvolution (P = .028, r = 0.564), mean BVdeconvolution (P = .001, r = 0.752), and max BVdeconvolution (P = .001, r = 0.771). Microvessel density correlated with max k-transdeconvolution (r = 0.564, P = .023). Vascular endothelial growth factor receptor-3 expression (receptor specific for lymphatics) correlated significantly with max k-transPatlak (P = .041, r = 0.686) and mean BFdeconvolution (P = .038, r = 0.695). k-Trans values of PCT do not correlate with ultrastructural microvessel features, whereas endothelial fenestrations correlate with increased intra-tumoral BVs.

Анализ лечения детей с воронкообразной деформацией грудной клетки. Наш опыт, эволюция хирургического подхода и результаты лечения

Pectus excavatum is the most common type of congenital chest wall abnormalities, which is observed in 0.6–2.3% of population and makes up 91% of all congenital chest deformities, and is often accompanied by severe functional disorders of the cardiovascular and bronchopulmonary systems. Discussions on the method of choice of thoracoplasty and fixation of the sternocostal complex are still ongoing until the present time. Objective: to analyse the treatment outcomes of children with pectus excavatum and choose the most optimal method of thoracoplasty. Material and methods. In the clinics of paediatric surgery of the Tyumen and Kirov State Universities during the period from 1990 to 2017, in total 209 children with pectus excavatum underwent surgical treatment. The indication for the operation was grade 2 and 3 according to the Gyzicka index (1962). The age of the patients varied from 4 to 18 (13.9±2.59) years old. There were 149 males. The patients were divided into two groups. The first group included 55 patients, operated according to the Bairov and Ravich technique. The second group comprised 154 children, who underwent thoracoplasty using the Nuss and Nuss-Vinogradov’s methods. Results. Duration of the operation in the 1st group was 134±10.51 minutes and the 2nd one – 39±4.33 minutes. In the first group, thoracoplasty was accompanied by blood loss of 150 – 500 mL, whereas in the second group there was no blood loss during the intervention (no more than 10 mL). In the postoperative period, the pneumothorax occurred in 28 (93.3%) children of the 1st group (all of these patients required the pleural drainage) and in 8 (6.35%) patients of the 2nd group, and only 5 (3.96%) of the latter required a pleural drainage. In the 1st group pain-reliefs were administrated up to 10 days and antibiotic therapy was prescribed up to 14 days on average, while in the 2nd group – the analgetic and antibiotic therapies continued up to 3-5 days. The average hospital stay in the first group was 41±4.42 days and in the second – 9±1.82 days. In three patients of the 1st group there was a relapse of the disease, which required repeated thoracoplasty. At the moment, the plate is removed in 37 (40.7%) patients of the 2nd group. Removal of the plate is carried out in 2-9 years after the initial correction, on average 4.83±2.48 years after installation. In the postoperative period, the patients were provided check-up examination in dynamics in 1, 6 and 12 months and then once a year. Conclusions. The correction procedure of pectus excavatum according to Nuss is safe and effective that allows obtaining a good cosmetic outcome and can be considered as a surgery of choice in the treatment of children.

Effect of Sodium Thiosulfate on Arterial Stiffness in End-Stage Renal Disease Patients Undergoing Chronic Hemodialysis (Sodium Thiosulfate-Hemodialysis Study): A Randomized Controlled Trial

Background: Arterial stiffness (AS) and vascular calcification are significantly related to a high cardiovascular mortality risk in hemodialysis (HD) patients. Intravenous sodium thiosulfate (IV STS) can prevent and delay the vascular calcification progression in uremic states; however, the STS effect on AS has not been assessed. This study aimed to evaluate the STS efficacy on vascular calcification and AS in HD patients. Methods: Fifty HD patients with abnormal AS, as measured via the cardio-ankle vascular index (CAVI ≥8), were prospectively randomized to open-label 12.5 g IV STS during the last HD hour twice weekly for 6 months (n = 24) or the usual care (control group; n = 26). Patients and treating physicians were not blinded. The CAVI, coronary artery calcification (CAC) score, hemodynamics, and biochemical parameters were measured at the baseline and at 3 and 6 months. Results: All the baseline parameters were comparable. The IV STS significantly reduced the CAVI when compared to the control group (mean CAVI difference = –0.53; 95% CI –1.00 to –0.06; p = 0.03). A significant CAVI improvement was seen in those patients without diabetes mellitus. The natural logarithm of the CAC volume score was significantly increased in the control group. The high sensitivity C-reactive protein level was slightly lowered in the IV STS group (not significant). Conclusion: The intradialytic STS treatment significantly reduced the AS, as measured by the CAVI, and stabilized the vascular calcification in the HD patients. STS may be a novel therapeutic strategy for delaying and treating the structural and functional vascular wall abnormalities in HD patients.

GLOBAL LONGITUDINAL STRAIN AND MECHANICAL DISPERSION IMPROVES RISK STRATIFICATION OF MALIGNANT VENTRICULAR ARRHYTHMIAS AND MAJOR ADVERSE CARDIAC EVENTS OVER EJECTION FRACTION ALONE

Moderate to severe impairment in Left ventricular ejection fraction (LVEF) has been shown to predict major adverse cardiac events (MACE). However LVEF is an estimate of LV contractility and does not provide information about regional wall abnormalities or the presence of myocardial scar. Recently

What's New in Congenital Scoliosis?

Congenital scoliosis is a failure of vertebral formation, segmentation, or a combination of the 2 arising from abnormal vertebral development during weeks 4 to 6 of gestation. The associated spinal deformity can be of varying severity and result in a stable or progressive deformity based on the type and location of the anomalous vertebra(e). Bracing for congenital scoliosis is rarely indicated, while recent reports have demonstrated the utility of serial derotational casting for longer curves with multiple anomalous vertebrae as an effective "time buying strategy" to delay the need for surgery. Earlier hemivertebra excision and short-segment posterior spinal fusion have been advocated to prevent future curve progression of the deformity and/or the development of large compensatory curves. It has been shown in recent long-term follow-up studies that growth rates of the vertebral body and spinal canal are not as dramatically affected by pedicle screw instrumentation at a young age as once thought. Growth friendly surgery with either spine-based or rib-based anchors has demonstrated good results with curve correction while maintaining spinal growth. Rib-based anchors are typically more commonly indicated in the setting of chest wall abnormalities and/or when spinal anatomy precludes placement of spinal instrumentation. Recently, magnetically controlled growing rods have shown promising results in several studies that include a small subset of congenital scoliosis cases. A literature search was performed to identify existing studies related to the treatment of congenital scoliosis published from January 1, 2005 to June 1, 2016. Databases included PubMed, Medline, and the Cochrane Library. The search was limited to English articles and yielded 36 papers. This project was initiated by the Pediatric Orthopaedic Society of North America Publications Committee and was reviewed and approved by the Pediatric Orthopaedic Society of North America Presidential Line. A total of 36 papers were selected for review based upon new findings. Classic manuscripts on congenital scoliosis are also included to provide sufficient background information. Congenital scoliosis represents a wide range of pathology from the simple, stable hemivertebra to the complex, progressive spinal deformity with chest wall abnormalities and associated cardiac, renal, and neural axis anomalies. This paper reviews the natural history and associated anomalies with congenital scoliosis as well as the most up-to-date classification schemes and various treatment options for the care of this challenging patient population. Level 5.

Characteristics of Cardioembolic Stroke Patient in Neurologic Ward Dr. Hasan Sadikin General Hospital Bandung

Stroke is the second most common cause of death worldwide after heart disease. About80% stroke cases are ischemic stroke. One of 4 people with ischemic stroke had cardioembolicstroke. Ninety percent of cardiac emboli obstruct cerebral blood vessels and causedneurological deficit. Cardioembolic stroke may be due to abnormalities in cardiac walls,rhythm, valve, or function. Stroke patients with cardiac abnormalities have poor prognosis. Thisretrospective descriptive study was done in May-June 2017. We collected 103 medical recordsof stroke patients from Department of Neurology, Dr. Hasan Sadikin General Hospital duringJanuary 2015- March 2016. Data regarding sex, age, education level, economic status, andcardiac abnormalities were recorded. Majority of subjects were female (53.4%). The mostfrequent age group was 45-65 years old (49.51%). Most subjects had low educational level(76.7%) and low economic status (77.67%). Among subjects, 41.75% had cardiac rhythmabnormalities, 29.13% had cardiac wall abnormalities, 14.56% had cardiac valveabnormalities, and 14.56% had cardiac function abnormalities. The most common cause ofcardioembolic stroke was atrial fibrillation.Keywords: cardioembolic stroke epidemiology, patient characteristics, cardiac disease

MRI-based detection of renal artery abnormalities related to renal denervation by catheter-based radiofrequency ablation in drug resistant hypertensive patients.

Endovascular renal denervation (RDN) using catheter-based radiofrequency (RF) ablation has emerged as a potential treatment option for drug-resistant hypertension. Its efficacy is currently under debate. We aimed to evaluate the capability of contrast-enhanced magnetic resonance imaging (MRI) to assess the effects of RDN on the renal arterial wall in patients presenting with drug-resistant hypertension. Patients were included prospectively following institutional review board approval and written informed consent. Renal arteries were imaged using a two-dimensional T1-weighted TSE sequence pre- and post-administration of a gadolinium-based contrast agent, before (D0), 2 days (D2) and 6 months (M6) after RDN. Mean enhancement of the wall (mENH) and mean wall thickness (mWT) were compared across time using an ANOVA with repeated measures and post-hoc paired t-test. Follow-up was completed for 23 patients (median age, 57 years; 16 men). The mENH at D2 (96.3 ± 36.0 %) was significantly higher than at D0 (61.1 ± 26.3%, p < 0.001) and M6 (66.1±22.7%, p < 0.001). Similarly, mWT was significantly higher at D2 (3.1 ± 0.4 m) than at D0 (2.7 ± 0.4mm, p < 0.001) and M6 (2.9 ± 0. 5 mm, p = 0.002). MRI demonstrated abnormalities of the arterial wall 2 days after RDN that had resolved at 6 months. • Contrast-enhanced MRI provides anatomic evidence of renal artery RF ablation • Temperature increase related to RF ablation induces transient arterial wall inflammation • Morphological effects observed 2 days post RF ablation are not visible after 6 months.

B-Flow and B-Mode Ultrasound Imaging in Carotid Fibromuscular Dysplasia.

Previous ultrasound studies in fibromuscular dysplasia (FMD) have largely reported on color flow imaging, power Doppler, and Doppler flow augmentation. We here report on arterial wall imaging findings by B-flow and B-mode in patients with carotid FMD. We retrospectively reviewed ultrasonographic findings in subjects with known or suspected FMD. All patients were evaluated with a standardized imaging protocol including Doppler, B-mode, and B-flow. Vessel wall abnormalities were classified as normal, luminal irregularities, or classical beading (fusiform dilatations). We identified 23 patients and 33 carotid arteries were found to be abnormal, of which 10 had classical beading and 23 showed endoluminal irregularities. Bilateral disease was present in 10/23 patients. In the classical beading cases, B-mode revealed isoechoic ridges, which protruded into the lumen, alternating with dilated arterial segments, which were also clearly demonstrated by B-flow imaging. In cases with endoluminal irregularities, B-mode and B-flow showed isoechoic subendothelial irregular thickening, which did not lead to a fusiform dilatory appearance of the artery. The average distal internal carotid artery peak systolic velocity of arteries with classical beading (123 ± 29 cm/second) was significantly greater than that of arteries with mild irregularities (94 ± 34 cm/second) (P = .024). Morphological arterial wall changes of FMD were well depicted by careful B-flow and B-mode imaging of the distal internal carotid artery. We would like to emphasize the utility of B-flow and B-mode in the noninvasive evaluation of FMD.

Bowel wall thickening: inquire or not inquire? Our guidelines.

Bowel wall thickening is not an uncommon finding among patient undergoing abdomen CT scan. It may be caused by neoplastic, inflammatory, infectious or ischaemic conditions but also be a normal variant. Although specific radiologic patterns may direct to a precise diagnosis, occasionally misidentification may occur. Thus, in the absence of guidelines, further and not always needed diagnostic procedures (colonoscopy, esophagogastroduodenoscopy or capsule endoscopy) are performed. We conducted a retrospective study on data collected from May 2016 to June 2017. We selected 40 adult patients, admitted in Emergency Department with "abdominal pain" and undergone an abdomen CT scan, in which bowel wall abnormalities were founded. 75% patients were found to have a benign condition vs 25% a malignant condition. In the stomach group, 50% were found to have a neoplasm, whilst 33.3% presented an aspecific pattern and 16.7% had an inflammatory disease. In the small bowel cluster, 33.3% patients had an ischaemic disease, 33.3% an aspecific pattern, 22.2% an inflammatory disease and 11.1% was diagnosed with cancer. In the colon group, 36% had an inflammatory disease, 24% a colon cancer, 24% an aspecific pattern and 16% an ischaemic condition. We recommend to perform a further endoscopic procedure to all patients with gastric or colonic wall abnormalities on CT scan, on the basis of growing rate of cancer and IBD. Capsule endoscopy should be taken into account in patients with severe symptoms and after a previous negative endoscopic examination.

Ранние маркеры сердечно-сосудистого риска у женщин с наследственной отягощенностью по сердечно-сосудистым заболеваниям

to identify early markers of development of cardiovascular diseases (CVD) in women. Female firstdegree relatives from 39 families formed 2 groups: families (n=19) containing mothers with arterial hypertension (AH) (group 1) and healthy daughters (group 1a); families (n=20) containing practically heathy mothers (group 2) and healthy daughters (group 2a). We assessed data of anamnesis, including registration of cardiovascular risk factors, and family history of CVD. Examination included registration of anthropometric parameters, automatic and manual measurement of intima-media thickness (IMT) and resistance indexes of brachiocephalic arteries (BCA). We also determined cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), and measured magnitude of β-adrenoreception of membranes (β-ARM) of erythrocytes in micro-quantities of venous blood. Mothers in both groups of families had excessive body mass or obesity. Mothers of group 1 had more pronounced signs of abdominal obesity (AO). They also had abnormalities of IMT and sings of subclinical atherosclerosis of BCA. CAVI in this group was significantly higher than in group 2. In group 1a median BMI (25.5 kg/m2) and waist/hip ratio were significantly higher than in group 2a. Daughters of group 1a contrary to group 2a had abnormalities of vascular wall: increased automatically measured IMT of carotid arteries and elevated CAVI. Arterial pressure and heart rate (HR) in group 1a were within limits of physiological norm but significantly higher than in group 2a. All included women had elevated β-ARM values but in group 1a this parameter was significantly higher than in group 2a and moderately correlated with HR. Risk factors of CVD development in women are AH, AO, high activity of the sympathoadrenal system. These factors provoke changes of vascular wall (elevation of its stiffness and early subclinical atherosclerosis). In daughters of mothers with AH important prognostic components of CVD risk in addition to family history of CVD are AO, systolic blood pressure (BP) >120 mm Hg, diastolic BP >78 mm Hg, HR approaching upper limit of physiological norm, and high CAVI (indicator of vascular wall stiffness).