Bilateral Sudden Hearing Loss Caused by Basilar Artery Dissection: A Case Report

Bilateral sudden sensorineural hearing loss (SNHL) is rare, but a possible symptom of vertebrobasilar ischemia. A 69-year-old female patient with hypertension and atrial fibrillation presented with bilateral sudden hearing loss and vertigo without other neurological symptoms. On examination, she had left-beating horizontal nystagmus with positive head impulse on the left side. Pure tone audiometry revealed severe SNHL on both sides. Brain computed tomography angiography showed a dissection in the proximal portion of the basilar artery (BA) with occlusion of the mid-BA and bilateral anterior inferior cerebellar arteries (AICA), which confirmed on transfemoral cerebral angiography (TFCA). Left common carotid angiography demonstrated retrograde blood flow into the BA and right AICA via the left posterior communicating artery. During TFCA, her right hearing loss dramatically improved. Nine days later, follow-up TFCA showed an improvement of antegrade flow of the BA and AICA. We suggest that vertebrobasilar ischemia can be suspected in patients with bilateral sudden SNHL who present with risk factors for stroke.

Brachial Artery “Low-Flow Mediated Constriction” Is Associated with Myocardial Perfusion Defect Severity and Mediated by an Altered Flow Pattern during Occlusion

<b><i>Introduction:</i></b> The relationship between low flow-mediated constriction (LFMC), a new proposed measure of endothelial function, with cardiovascular disease severity and its hypothesized stimulus, that is, low flow, has not been comprehensively evaluated. The study evaluated association between change in brachial artery diameter during constriction with severity of myocardial perfusion defect (PD) and alterations in different components of flow profile. <b><i>Methods:</i></b> Brachial artery responses to occlusion were assessed in 91 patients and 30 healthy subjects. Change in anterograde and retrograde blood flow velocities (delta anterograde blood flow velocity and retrograde blood flow velocity), anterograde shear rate and retrograde shear rate (delta ASR and RSR, respectively), and oscillatory shear index (delta) during forearm occlusion at 50 mm Hg above systolic pressure, from baseline was calculated. Myocardial perfusion was evaluated in patients using exercise single positron emission computed tomography and % myocardial PD was calculated from summed stress score. <b><i>Results:</i></b> LFMC emerged as independent predictor of defect severity after correcting for age and gender (<i>p</i> = 0.014). Sixty-seven patients (73.6%) and 15 healthy subjects (50%) showed constriction during occlusion. In stepwise backward regression analysis, RSR contributed 35.5% and ASR contributed 20.1% of the total 63.9% variability in artery diameter during occlusion. <b><i>Conclusion:</i></b> The results suggest that LFMC is independently associated with myocardial perfusion severity and is “mediated” by an altered flow profile during occlusion.

Lancisi’s Sign: Giant C-V waves with Severe Tricuspid Regurgitation in Isolated Tricuspid Valve Prolapse

IIntroduction Isolated tricuspid valve prolapse (TVP) is a rare finding on transthoracic echocardiography. Right atrial enlargement or prominent ” v ” waves as a consequence of hemodynamic changes in severe tricuspid regurgitation (TR) are rarely seen with isolated TVP. Here is a case of isolated prolapse of anterior tricuspid leaflet presenting with giant C-V waves also known as Lancisi’s sign. Case Report A 66-year-old male presented with increasing exercise limitation and leg edema in recent months and was complaining about the persistent pulsation at his neck and elevated jugular venous pulse with prominent systolic pulsation that represents giant C-V waves, also known as ‘Lancisi’s sign’ consequence of severe TR due to isolated prolapse of the anterior leaflet.The patients’ symptoms resolved completely after tricuspid valve replacement. Discussion TVP is best defined at parasternal short axis view with more than 2 mm atrial displacement (AD) of leaflet/leaflets. TVP can also be detected from four chamber view with more than 2 mm AD or in right ventricular inflow view with more than 4 mm AD. As a consequence of TVP, the physiological jugular venous waveform alters due to severe TR.During severe TR; retrograde blood flow through right atrium during ventricular systole restrains x descent and produces a fusion of c and v waves that appears as a large pulsation in physical examination called as ‘Lancisi’s sign’ Conclusion ‘Lancisi’s sign’ is defined as a large visible systolic neck pulsation as a consequence of the c-v waves fusion by preventing x descent during severe TR.

To the issue of degree of removal of gliomas of supratentorial localization

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

Possibility of increasing the «therapeutic window» for revascularization of the carotid arteries in the acute period of ischemic stroke

Objective ‒ to assess the possibility of increasing the time of surgical restoration of blood flow in the acute period of ischemic stroke due to occlusive lesion of the internal carotid artery (ICA).Materials and methods. Among the patients who were admitted for treatmentat in the Regional Odessa Hospital with acute ischemic stroke in the carotid region a group of 6 patients was identified in whom the cause of stroke was occlusion of the ICA by an atherosclerotic plaque. Age of patients ‒ from 54 to 71 years. Patients were hospitalized later 6 hours from the onset of stroke. The survey was carried out according to the established protocol. Neurological deficits are mild to moderate. In order to eliminate the occlusion of the ICA, all patients underwent endarterectomy.Results. Carotidendarterectomy was performed from 2 to 11 days after onset of stroke. Retrograde blood flow through the ICA was obtained in three (50 %) patients in whom surgical interventions were performed up to 4 days after the disease. In the postoperativeperiod a typical therapy was carried out. In cases with the obtained retrograde blood flowon control carotid angiograms demonstrated revascularization of the ICA basin according to mTICI-3. On the control CT of the brain in postoperative period in one case the point subarachnoid hemorrhages was determined. In the other two cases there was no evidence hemorrhagic transformation. Operated patients showed positive dynamics: a decrease hemiparesis by 1 poin and regression of mental disorders. The patients were discharged withm RS 1‒2. During the follow-up examination 90 days the neurological condition of the patients improved to mRS 1‒0.Conclusions. Results obtained in increasing the “therapeutic window” for revascularization of the occluded ICA allow to continue research in the indicated direction and improve the quality of surgical care for patients with acute stroke.

Prediction of persistence of hemodynamically significant open arterial duct in profoundlypreterm infants

Objective. To develop a method for predicting the persistence of hemodynamically significant ductus arteriosus in profoundly premature newborns based on the evaluation of clinical data and the results of additional studies. Material and methods. Sixty-nine profoundly preterm newborns were examined including 37 with very low and 32 with extremely low body weight. Clinical and anamnestic data, the results of laboratory radiographic and instrumental examinations were evaluated. The state of the arterial duct, as well as the parameters of central and intracardiac hemodynamics were determined by echocardiography. The criteria for hemodynamically significant open arterial duct (OAD) were the following: duct size greater than 1.5 mm, left-right blood bypass, the presence of retrograde blood flow in the aorta greater than 50 % of the antegrade value. There were 2 groups: comparison (n = 41) children with hemodynamically insignificant ductus arteriosus, main (n = 28) children with hemodynamically significant ductus arteriosus after 72 hours of postnatal life. Results. After 72 hours of the postnatal life, a hemodynamically significant ductus arteriosus is detected in 40.6 % of profoundly premature newborns. The factors of a long-term persistence of ductus arteriosus are as follows: birth at term of gestation less than 27 weeks with a low Apgar score within the first minute of life ( 4 points), a patient has a sharp weakening or absence of reflexes of the newborn, severe muscular hypotonia, signs of peripheral circulation, moist fine wheezing and crepitation in the lungs, strengthening of their images on the radiograph due to the interstitial and vascular components, dilation of the left and right ventricles and the left atrium. The method for predicting the dynamics of the open ductus arteriosus in profoundly premature newborns has been developed. Conclusion. The use of the developed prognostic table makes it possible to identify with an accuracy of 85.7 % profoundly premature newborns with a high risk of persistence of a hemodynamically significant ductus arteriosus after 72 hours of postnatal life.

HEMODYNAMIC DISORDERS IN VARICOSE VEIN DISEASE

Aim. Duplex ultrasound scanning (DUS) is a routine diagnostic procedure in patients with varicose vein disease. DUS mostly evaluates the qualitative (anatomical) parameters of the disease. Still, it is difficult to assess the microcirculatory parameters in trophic disorders based only on the anatomy, therefore assessment of quantitative blood flow parameters is needed. Our aim was to determine the potentials of conventional DUS in assessment of the hemodynamic disorders in patients with varicose disease. Materials and Methods. The study included 583 patients with varicose disease, 348 of which had trophic alterations. The patients were divided into 4 groups according to the CEAP clinical classes. Standard Valsalva and Siegel tests were performed during DUS. The following parameters were assessed in the superficial and deep veins: diameter of veins, antegrade blood flow velocity, retrograde blood flow velocity, reflux time; in the perforator veins (PV) – diameter, maximum velocity and average velocity of reflux. Peripheral resistance index (RI) in the arteries accompanying the PV was also analyzed. Results. A statistically significant difference in the diameter of the GSV was obtained between classes C2 and C3, C3 and C4, but not between class C5, 6 and class C4. Similar findings were observed in the assessment of diameter of the PVs and the velocity of retrograde blood flow through them. A gradual increase in these parameters could be seen with the progression of the disease, but a statistically significant difference was obtained only between classes C2 and C3 for the diameter of the PV and the peak velocity of retrograde blood flow. As for the average blood flow velocity, a statistically significant difference was obtained between classes C2 and C3, C3 and C4. Arteries in the perforator bundles demonstrated low RI which may be attributed to the presence of an arteriolo-venular bypass. Statistically significant differences were obtained for CEAP classes C2 and C3. Conclusions. Ultrasound duplex scanning of the study with use of Superb Micro-Vascular Imaging mode is an effective method in assessing the quantitative and microcirculatory parameters of hemodynamic disorders in patients with varicose vein disease of the lower extremities. Trophic ulcers in varicose vein disease are not an obligatory component of the disease, but only its complication.

Hematemesis, a Rare Presentation for Downhill Esophageal Varices

Downhill esophageal varices (DEV) are a rare form of esophageal varices associated with superior vena cava obstruction. Obstruction leads to retrograde blood flow through collateral venous channels, including the esophageal venous plexus, to redirect blood flow to the right atrium via the inferior vena cava. This leads to the formation of DEV. It is a rare phenomenon to have gastrointestinal bleeding, especially hematemesis, on a patient’s first presentation with this disease process. We describe such a case here involving a patient with DEV secondary to metastatic renal cell carcinoma presenting with hematemesis.

Morphological study of the valve apparatus superficial venous system of the human penis

Introduction. Available insufficient and contradictory data on the presence, structure and possible role of the valves of the penile veins determined the aim of the study.The study objective is the examination of the valve apparatus of the deep dorsal (DDV) and superficial dorsal veins (SDV) of the human penis.Materials and methods. The material was veins obtained at the autopsy by microdissection from the coronal sulcus to the base of the penis – 51 cases – and cross sections of cavernous bodies distal to the suspensory ligament – 103 cases – a total of 154 observations. Standard histological techniques were used. Staining with hematoxilin and eosin, fuchsin and picrofuchsin, Mallory staining were used.Results. Two branches of the DDV were identified in 7.8 % of observations, usually as a division of the main trunk. DDV valves were found in 92.2 % of the observations, with the frequency of occurrence immediately distal to the suspensory ligament being about 38 %. Perhaps the valves of this localization play the role of an osteal valve. Valves were detected in 75 % of the cases in the studied area of SDV. A total of 190 valve images were obtained and analyzed. The valves have a well developed roller, collagen and smooth muscle fibers of which are woven into the middle shell of the vein wall. The base of the valve roller has fibers located in intersecting planes, which strengthens it. The flaps of the valve are thin and consist mainly of collagen fibers. Valves of DDV and SDV have a similar structure. Valves are regularly found in the envelope veins, the perforant veins of the tunica albuginea, the veins of the subshell venous plexus, the paraurethral veins. All valves have a clear orientation, aimed at unilateral outflow of blood from the penis.Conclusion. The results of the study indicate the presence of a formed valvular apparatus in the veins of the human penis, which provides unidirectional venous outflow from the cavernous bodies, preventing retrograde blood flow. The findings add to existing knowledge about the structure of the valvular apparatus of the penile veins and its potential role in erectile function and dysfunction.