Logistic Regression Analysis of the Influencing Factors of Cryptogenic Stroke with Positive c-TCD

Objective: To explore the influencing factors and logistic regression characteristics of cryptogenic stroke in patients with positive transcranial doppler bubble test (c-TCD). Methods: A total of 134 cases of cryptogenic stroke that were diagnosed by Tianshui First People’s Hospital from November 2018 to April 2020 were selected according to the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification criteria. According to c-TCD results, there were 70 cases of right to left shunt that were included in the positive group and 64 cases without right to left shunt in the negative group. Gender, age, smoking, diabetes, hypertension, and factors affecting the positive rate of foam were analyzed. According to the abnormal embolism scale scores, logistic regression equation was used to analyze the independent influencing factors. Results: The influencing factors of cryptogenic stroke in patients with positive c-TCD were correlated with age, gender, and abnormal embolism scale scores (p < 0.05). For each grade increase in age, the proportion of positive foam test was calculated to be 3.21 times, and the proportion of female to male was calculated to be 2.25 times. For each grade increase in the scores, the proportion of positive foam test was calculated to be 2.55 times. Conclusion: Female, older age, and higher scores in the abnormal embolism scale are the influencing factors for cryptogenic stroke in patients with positive c-TCD.

A case report of a triad causing platypnoea–orthodeoxia syndrome

Background Platypnoea–orthodeoxia syndrome (POS) is a rare condition characterized by hypoxaemia and dyspnoea when changing from a recumbent to an upright position. Diagnosis requires a high clinical suspicion and is often underdiagnosed. Case summary We report a case of POS in a 50-year-old woman with dyspnoea and new-onset atrial fibrillation. Oxygen saturation and dyspnoea worsened as she changed from a supine to a sitting position (96 vs. 86%, respectively). Transoesophageal echocardiography demonstrated enlargement of both atria and right ventricle with reduced systolic function and a large Chiari network (CN). Colour Doppler discovered severe tricuspid regurgitation with tenting and tethering of the valve leaflets. Finally, a bubble test revealed the cause of POS to be a patent foramen ovale along with the severe tricuspid regurgitant jet moving into the left atrium and favoured by the CN. Surgical closure of the foramen ovale resulted in the resolution of symptoms. Discussion Platypnoea–orthodeoxia syndrome is most commonly caused by a right-to-left shunt through an anatomical defect of the interatrial septum, typically a patent foramen ovale, combined with elevated right atrium pressure. This case illustrates an uncommon cause of POS in the absence of elevated atrium pressure due to the interplay of three key elements: a patent foramen ovale, tricuspid regurgitation, and the CN. Our aim is to alert physicians to the possibility of an intracardiac shunt as the cause of unexplained and/or refractory hypoxaemia related to position changes. Early recognition of this syndrome promotes timely treatment, greatly improving patient outcomes.

An ultrasound-based technique in the management of totally implantable venous access devices with persistent withdrawal occlusion

Persistent withdrawal occlusion is a specific catheter malfunction characterized by inability to withdraw blood through the device while infusion is maintained. The main causes are fibroblastic sleeve and tip malposition (associated or not to venous thrombosis around the tip). All current guidelines recommend infusing vesicant/antiblastic drugs through a central venous port only after assessment of blood return. In PWO, blood return is impossible. We have recently started to assess the intravascular position of the tip and the delivery of the infusion in the proximity of the cavo-atrial junction utilizing transthoracic/subxiphoid ultrasound with the ‘bubble test’. We found that this is an easy, real-time, accurate and safe method for verifying the possibility of using a port for chemotherapy even in the absence of blood return, as it occurs with persistent withdrawal occlusion.

Unusual malposition of a peripherally inserted central catheter into the left pericardiophrenic vein: A case report

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.

Pineal Region Hemangioblastoma Resection Through Paramedian Supracerebellar Approach: 2-Dimensional Operative Video

Pineal region tumors remain challenging lesions to safely resect because of their central location.1 Patients frequently present with symptoms associated with hydrocephalus and brainstem compression.2 Local anatomy, primarily the tentorium angle and venous anatomy, plays a central role in the selection of the approach.3 The paramedian supracerebellar approach pioneered by Yaşargil in 19844 allows to access the pineal region through a less steep angle while avoiding the central thickened arachnoid and midline cerebellar and vermian veins.3 Although the author strongly prefers the advantageous three-quarter concord position, this early case was performed in a sitting position, which requires a bubble test to rule out the presence of a persistent foramen ovale. The preoperative pineal differential diagnosis should be exhaustive, including blood and cerebrospinal fluid (CSF) tumor markers in suitable cases. Hemangioblastomas are seldom found or expected in the pineal area, and the surgeon must be alarmed by their typical “cherry nodule” appearance.2,5 Their recognition prior to resection is paramount in avoiding excessive blood loss from tumor entry. Similar to arteriovenous malformations, hemangioblastoma surgical tenets include en bloc resection and preservation of the main draining veins until the last steps of the resection. Von Hippel-Lindau (VHL) syndrome genetic workup is necessary is similar patients, as more than 25% of hemangioblastomas are associated with VHL tumor suppressor gene mutations in chromosome 3.2 The patient consented to the surgery and use of her photography. Image at 2:41 from Ueyama et al, Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations, Neurosurgery, 1998, 43(5),3 used with permission from the Congress of Neurological Surgeons.

Wood Permeability Assessment of Young Teak (Tectona grandis L.f.)

Wood properties of young teak (Tectona grandis L.f.) is inferior, and then preservative treatment is one possible solution to enhance its service life. The uptake and movement of preservatives through wood cell structure is directly connected to the wood permeability. There are two simple methods to identify wood permeability: water soaking and bubble test methods. This paper assesses the young teak permeability by water soaking and bubble test methods. The assessment was conducted into five cm thick young-teak discs by soaking in the red-dye water and blowing air into the discs which had been coated with soap. Results show that the heartwood is less permeable than sapwood. Red-dye penetrates almost 100% of the sapwood area, and the red-dye did not penetrate in the heartwood. Red-dye only penetrates in the cracked heartwood through the void volume in the cracking heartwood. There is a transition zone between sapwood and heartwood, and it is refractory. Bubble test with air pressure from compressor could open the air-pathway in the heartwood and sapwood of young-teak discs taken from Bogor. The bubble test result of young-teak discs from Madiun showed air-pathway only in the sapwood, but heartwood. The air pressure is not capable of moving the vapour through the wood cell. It indicates that the heartwood of young-teak from Madiun is less permeable and less possibility for pressure treatment.

Pulmonary Arteriovenous Malformation as a Cause of Exercise Intolerance in Children: A Case Report

Pulmonary arteriovenous malformation (PAVMs) in children are rare lesions characterized by abnormal low resistance vascular structures connecting a pulmonary artery to a pulmonary vein, resulting in an intrapulmonary right-to-left shunt. The insidious onset and variable signs&amp;nbsp;and symptoms make diagnosis difficult, especially in children. PAVMs&amp;nbsp; can be single or multiple, congenital or acquired, and up to 47-80% of cases are associated with hereditary hemorrhagic telangiectasia (HHT).We present the&amp;nbsp; case of a 12-year-old female teenager referred to our center for epistaxis, headache, fatigue and weakness, with evidence of mild oxygen desaturation.&amp;nbsp; Bubble test showed a right-to-left shunt and pulmonary angio-CT confirmed the diagnosis. Percutaneous selective embolization was performed with full recovery of normal arterial oxygen saturation. When differentiating between mild oxygen desaturation and exercise intolerance in children and adolescents, physicians should be aware of the possibility of PAVMs as a cause.&amp;nbsp;