Spontaneous Closure of a Carotid-cavernous Fistula after Contrast-enhanced Orbit Computed Tomography

Purpose: We report a case of spontaneous closure of a carotid-cavernous fistula (CCF) after contrast-enhanced orbit computed tomography (CT).Case summary: A 80-year-old female was referred to our clinic under suspicion of chronic angle- closure glaucoma because of persistently high intraocular pressure commencing one month prior. Slit-lamp examination revealed a conjunctival injection and corkscrew-like vessel dilatation in the left eye, and a high intraocular pressure. Dilated fundus examination revealed central retinal vein occlusion in that eye. Contrast-enhanced orbit CT revealed a dilated, superior ophthalmic vein in the left orbit, and she was transferred to our department of neurosurgery for digital subtraction angiography (DSA); this is the gold standard imaging modality for the diagnosis of direct and indirect CCFs. DSA was performed two weeks after orbit CT; however, no CCF was visible. Thereafter, the conjunctival injection and the elevated intraocular pressure improved gradually over eight months. We suspect that the CCF closed spontaneously.Conclusions: Our case highlights the fact that a CCF can close spontaneously after contrast-enhanced orbit CT; ophthalmologists may wish to bear this in mind.

Quantification of Retinal Vessel Myogenic Constriction in Response to Blood Pressure Peaks: Implications for Flicker Light-Induced Dilatation

Background/AimsFlicker-light induced retinal vessel dilatation (FID), a marker of microvascular endothelial function, has been shown to be blunted in sedentary cardiovascular risk patients (SR) as well as healthy physically active individuals (HA). This study aimed to quantify the retinal myogenic response to blood pressure (BP) peaks and its effects on consecutive FID for differentiation of microvascular health.MethodsTen HA and eleven SR with a previously established restriction of arteriolar FID (aFID) (<2.2%) were invited in order to assess BP-induced myogenic constriction following a standardized handgrip task and a consecutive FID. BP was measured beat-to-beat.ResultsThe complete dataset of nine HA (3 female, mean age 65 years) and nine SR (5 female, mean age 61 years) individuals was analyzed. The central retinal arteriolar diameter equivalent (CRAE) was 183 ± 11 μm for HA and 176 ± 20 μm for SR. Initial baseline aFID was 1.6 ± 0.4% in HA and 1.6 ± 0.7% in SR. Systolic (p = 0.334) and diastolic (p = 0.245) BP increase following the handgrip task was in the range of 20–30% and comparable in both groups. BP increase was followed by a significantly higher arteriolar (−2.9 ± 1.3% vs. −1.3 ± 0.6%, p < 0.01) myogenic constriction in HA compared to SR. Moreover, in the consecutive assessment of FID directly after the BP-induced vessel constriction, aFID (4.1 ± 2.0% vs. 1.6 ± 0.9%, p < 0.01) was higher in HA compared to SR.ConclusionInitial baseline aFID was blunted in HA and SR. Retinal myogenic constriction was impaired in SR compared to HA. The consecutive aFID after BP-induced myogenic constriction recovered in HA but remained blunted in SR. Additional assessment of retinal myogenic constriction needs to be considered to improve CV risk stratification and reduce false-positive findings of endothelial dysfunction in otherwise healthy active individuals.Clinical Trial RegistrationClinicalTrials.gov: NCT03986892 (https://clinicaltrials.gov/ct2/show/NCT03986892).

Comparison of initial thin-section CT features in coronavirus disease 2019 pneumonia and other community-acquired pneumonia

Background Coronavirus disease 2019 (COVID-19) pneumonia caused similar symptoms to other community-acquired pneumonia (CAP). It is important to early quarantine suspected patients with COVID-19 pneumonia from patients with other CAP to reduce cross infection. The purpose of the study is to review and compare initial thin-section computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia and other community-acquired pneumonia (CAP). Methods 24 cases of COVID-19 pneumonia (14 males and 10 females; age range, 14-87 years; mean age, 48.0 years) and 28 cases of CAP caused by other pathogens (13 males and 15 females; age range, 24-85 years; mean age, 49.5 years) were included. Thin-section CT features of the lungs for all patients were retrospectively reviewed by two independent radiologists. Results There were no significant differences for the shape of main lesions, pure ground glass attenuation (GGA), mixed GGA with consolidation, air bronchogram, linear opacities, halo sign/reversed halo sign, cavitation and lymphadenopathy between the group of COVID-19 pneumonia and the group of other CAP. However, the frequency of crazy-paving appearance, vessel dilatation, bilaterally involvement and peripherally distribution were significantly higher in patients with COVID-19 compared with other CAP ( p =0.031, p =0.000, p =0.029 and p =0.009, respectively). Conversely, the frequencies of pure consolidation, tree-in-bud sign and pleural effusion were significantly higher in patients with CAP than in patients with COVID-19 pneumonia ( p =0.002, p =0.000 and p =0.048, respectively). Conclusion There are considerable overlaps in thin-section CT features between COVID-19 pneumonia and other CAP. However, the presence of crazy paving pattern, vessel dilation, bilateral involvement and peripheral distribution contributes to the diagnosis of COVID-19 pneumonia. While the presence of pure consolidation tree-in-bud sign, pleural effusion can be assisting in exclusive the diagnosis of COVID-19 pneumonia.

In vitro and in vivo testing of a novel local nicardipine delivery system to the brain: a preclinical study

OBJECTIVEThe management of patients with aneurysmal subarachnoid hemorrhage (aSAH) remains a highly demanding challenge in critical care medicine. Despite all efforts, the calcium channel antagonist nimodipine remains the only drug approved for improving outcomes after aSAH. However, in its current form of application, it provides less than optimal efficacy and causes dose-limiting hypotension in a substantial number of patients. Here, the authors tested in vitro the release dynamics of a novel formulation of the calcium channel blocker nicardipine and in vivo local tolerance and tissue reaction using a chronic cranial window model in mice.METHODSTo characterize the release kinetics in vitro, dissolution experiments were performed using artificial cerebrospinal fluid over a time period of 21 days. The excipients used in this formulation (NicaPlant) for sustained nicardipine release are a mixture of two completely degradable polymers. A chronic cranial window in C57BL/6 mice was prepared, and NicaPlant slices were placed in proximity to the exposed cerebral vasculature. Epifluorescence video microscopy was performed right after implantation and on days 3 and 7 after surgery. Vessel diameter of the arteries and veins, vessel permeability, vessel configuration, and leukocyte–endothelial cell interaction were quantified by computer-assisted analysis. Immunofluorescence staining was performed to analyze inflammatory reactions and neuronal alterations.RESULTSIn vitro the nicardipine release profile showed an almost linear curve with about 80% release at day 15 and full release at day 21. In vivo epifluorescence video microscopy showed a significantly higher arterial vessel diameter in the NicaPlant group due to vessel dilatation (21.6 ± 2.6 µm vs 17.8 ± 1.5 µm in controls, p < 0.01) confirming vasoactivity of the implant, whereas the venous diameter was not affected. Vessel dilatation did not have any influence on the vessel permeability measured by contrast extravasation of the fluorescent dye in epifluorescence microscopy. Further, an increased leukocyte–endothelial cell interaction due to the implant could not be detected. Histological analysis did not show any microglial activation or accumulation. No structural neuronal changes were observed.CONCLUSIONSNicaPlant provides continuous in vitro release of nicardipine over a 3-week observation period. In vivo testing confirmed vasoactivity and lack of toxicity. The local application of this novel nicardipine delivery system to the subarachnoid space is a promising tool to improve patient outcomes while avoiding systemic side effects.

Botulin Toxin Use in Rosacea and Facial Flushing Treatment

Botulinum toxin (BTX) is a neurotoxin derived from the Clostridium botulinum bacterium that inhibits the release of acetylcholine at the neuromuscular junction level whose effects has been used for many years to treat a variety of muscular/neuromuscular conditions and more recently also for cosmetic use. BTX has experimented in some dermatological conditions, which include Rosacea and facial flushing treatment with good results. The complex mechanism underlying those results is not completely understood but was proposed a release inhibition of acetylcholine from peripheral autonomic nerves of the cutaneous vasodilatory system combined with the blockade substance P and calcitonin gene-related peptide (CGRP) thus modulating blood vessel dilatation. We analysed the published data on BTX off label applications rosacea and flushing retrieved from PubMed.

Analysis of Heat Pressure with Systolic-Diastolic Blood Pressure and Fatigue in Karak Industrial Workers Gadingan Sukoharjo

The Karak industry is a food processing industry that has the potential danger of heat stress. Heat pressure can cause workers to experience health problems, especially if peripheral blood vessel dilatation causes circulatory disorders and can also cause fatigue. The aim of this study to analyze the heat pressure with blood pressure and fatigue in Karak industrial worker. This type of research is observational analytic, cross-sectional design with purposive sampling consist of 106 respondents. Test statistical data of research with Spearman Correlation. The Karak industry workplace has a WetBulb Globe Temperature (WBGT) 34oC in 8 hours/day with mild workloads. The significance of the relationship between heat pressure and systolic-diastolic blood pressure about p = 0.034 and p = 0.031; the value of r = -0,338 and r = -0,358 which means the strength of the correlation is weak. And the significance of heat pressure with fatigue is p-value = 0.039 and r = -0.581 (the strength of the medium correlation). There was a correlation between heat pressure and systolic-diastolic blood pressure and fatigue in Karak industrial workers Gadingan Sukoharjo.

Identification of Eyes At Risk for Severe Retinopathy of Prematurity (ROP) by Third Year Ophthalmology Residents in a Tertiary Hospital

Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P < 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.