Evaluation of 40 hemifacial spasm patients with MR angiography of the brain and vertebral artery dominance in the etiology of hemifacial spasm

Objectives: Hemifacial spasm is characterised by involuntary, rhythmic, tonic or clonic contractions originating from the facial nerve and occurring intermittently in unilateral facial muscles. The most commonly reported cause of hemifacial spasm is the compression of the facial nerve at its root exit/ entry zone by an ectatic or aberrant blood vessel, leading to local demyelination. In this study, we compared magnetic resonance angiography (MRA) findings from patients with hemifacial spasm and controls to determine whether vertebral artery dominance is part of the aetiology of this condition. Methods: This retrospective case-control study was conducted with data from 40 patients with hemifacial spasm who received botulinum toxin injections and for whom MRA findings were accessible, and 42 patients of similar age and sex who presented with symptoms of nonspecific headache in the outpatient neurology clinic. Magnetic resonance imaging and unenhanced time-of-flight MRA examinations from the study and control groups were evaluated. Results: A dominant vertebral artery was present in 52.2% of patients in the hemifacial spasm group and 33.3% of those in the control group, but this difference was not significant (p = 0.079). Conclusions: The lack of significant results supporting our hypothesis may be attributable to the small study population. Further studies with larger groups are warranted.

Potential Relation between Plasma BDNF Levels and Human Coronary Plaque Morphology

Coronary artery disease (CAD) patients are at high ischemic risk, and new biomarkers reflecting atherosclerotic disease severity and coronary plaque vulnerability are required. The Brain-Derived Neurotrophic Factor (BDNF) affects endothelial and macrophage activation suggesting its involvement in atherosclerotic plaque behavior. To investigate whether plasma BDNF is associated with in vivo coronary plaque features, assessed by optical coherence tomography (OCT), in both acute myocardial infarction (AMI) and stable angina (SA) patients, we enrolled 55 CAD patients (31 SA and 24 AMI), and 21 healthy subjects (HS). BDNF was lower in CAD patients than in HS (p < 0.0001), and it decreased with the presence, clinical acuity and severity of CAD. The greater BDNF levels were associated with OCT features of plaque vulnerability in overall CAD as well as in SA and AMI patients (p < 0.03). Specifically, in SA patients, BDNF correlated positively with macrophages’ infiltration within atherosclerotic plaque (p = 0.01) and inversely with minimal lumen area (p = 0.02). In AMI patients a negative correlation between BDNF and cap thickness was found (p = 0.02). Despite a small study population, our data suggest a relationship between BDNF and coronary plaque vulnerability, showing that vulnerable plaque is positively associated with plasma BDNF levels, regardless of the clinical CAD manifestation.

Paget’s Disease of Bone and Cardiovascular Risk: a Pilot Study

Background: The association between Paget’s disease of bone (PDB) and increased cardiovascular (CV) risk has been suggested, but the literature is conflicting. Objective: Our study aimed to evaluate two markers of CV risk [common carotid artery intima-media thickness (cIMT) and the aortic pulse wave velocity (PWV)] in patients with PDB. Methods: We enrolled 12 patients with PDB and 58 control subjects, matched for age. Diagnosis of PDB was based on clinical, radiological and biochemical parameters. Results: Patients with PDB showed higher PWV values than the controls, whereas cIMT was slightly but not significantly increased. Conclusion: These findings, although limited by the small study population, represent an original observation that deserves further study. The higher arterial stiffness in PDB could be related to the increased bone turnover or to the high levels of oxidative stress that characterize this population.

Making friends with your team: The benefits of raising learner awareness of intra-team relations

To highlight the importance of teamwork and intra-team relationships beyond the classroom, in a small study population of undergraduate students of Translation studies, we have attempted to raise awareness of teamwork processes so as to empower learners in managing their interaction and ensure they gain valuable pre-professional experience. Following specific input and the construction of randomized teams, we questioned learners about their previous and current experience of teamwork, their knowledge of team colleagues and the changes their relationships underwent, and prior academic performance versus expectations of current performance and how teamwork might influence this. Our results indicate teamwork substantially improved levels of intimacy, enhanced the quality of the experience, and raised awareness of the benefits of the team per se. However, some learners recognized personal difficulties with teamwork that they were unable to overcome and, in this context, “people problems” became increasingly important. Nonetheless, learners were convinced that teamwork would have a positive influence on their final grades.

Single-centre study of the diagnostic performance of plasma metanephrines with seated sampling for the diagnosis of phaeochromocytoma/paraganglioma

Background Measurement of plasma metanephrines is regarded as one of the best screening tests for phaeochromocytoma/paraganglioma. Current guidelines recommend that samples are ideally collected in the supine position after 30 min rest and interpreted using supine reference ranges, in order to optimize the diagnostic performance of the test. Current practice in our centre is to collect samples for plasma metanephrines from seated patients. The aim of the study was to determine, if seated sampling for plasma metanephrines provides acceptable diagnostic performance in our centre. Methods Clinical and laboratory data of 113 patients, gathered over a four-year period 2010–2014, were reviewed. All had undergone preoperative plasma metanephrines measurement and had postoperative histopathology confirmation or exclusion of phaeochromocytoma/paraganglioma. Results Of 113 patients included in the study, 40 had a histological diagnosis of phaeochromocytoma/paraganglioma. The remaining 73 patients had an alternative adrenal pathology. The diagnostic sensitivity of normetanephrine or metanephrine above the upper limit of our in-house seated reference range was 93%. However, excluding three cases of paraganglioma determined clinically and biochemically to be non-functional raised the sensitivity to 100%. Diagnostic specificity was 90%. Applying published supine reference ranges made no difference to diagnostic sensitivity in this group of patients but decreased diagnostic specificity to 75%. Conclusions While these data are derived from a relatively small study population, they demonstrate acceptable diagnostic performance for seated plasma metanephrines as a screening test for phaeochromocytoma/paraganglioma. These data highlight a high diagnostic sensitivity for plasma metanephrines with seated sampling in our centre.

S297 – Nasal Surgery for Obstructive Sleep Apnea Syndrome

Objectives Using evidence-based methodology, we report the literature review findings concerning nasal surgery and OSAS. Methods The MedLine, EMBRASE, Cochrane databases are searched (1960-; 2008) using subject headings “nasal surgery,” “sleep apnea,” “snoring,” or “sleep disorder.” Letters to editor, case reports, review articles, and non-English publications are excluded. Data extracted from these articles are used for critical appraisal and are analyzed using meta-analysis and data-synthesis technology. Results Patients pooling revealed gender distribution (90% male), with a mean age of 48 years, and respiratory disturbance index (RDI) ranged from 6.2 to 83.6 event/hr. Baseline BMI spanning from 25.9 to 35.7 kg/m2 was recorded in 10 articles. Total nasal resistance from 2.7 to 5.8cm H2O/L/S was measured in 5 articles. In 13 articles, nasal surgery is the only procedure that applied to patients. 5 articles report significant improvement in AHI; 2 of nasal-surgery only and 3 of nasal with oropharyngeal surgery. The success rate was statistically significant between “nasal surgery-only” and “nasal with oropharynx surgeries-together” articles (15.8–57% vs 40–82%, P=0.03). Although significant improvement in nasal obstruction and concomitant quality of life were mentioned in aforementioned articles, there were no universal measures to present a coherent analysis. Conclusions Nasal surgery might be efficacious in treating OSAS-related symptoms. However, the meta-analysis does not support the efficacy of exclusive nasal surgery for sleep apnea in regard to the success rate. Heterogeneity in small study population and incoherence of outcomes measures limit the study and warrant further research.

Accuracy of MRCP compared to ERCP in the diagnosis of bile duct disorders

AIM: To determine the accuracy of Magnetic Resonance Cholangiopancreatography compared to the gold standard Endoscopic Retrograde Cholangiopancreatography in the diagnosis of bile duct disorders at our institution. PATIENTS AND METHODS: 52 patients with suspected pancreatobiliary pathology were included in this prospective observational study. MRCP was performed in the 24-hour period prior to the ERCP. RESULTS: MRCP had sensitivity, specificity, positive and negative predictive values of 87%, 80%, 83.3% and 84.2% respectively for choledocholitiasis which correlates well with results obtained in other parts of the world. CONCLUSION: At our institution, MRCP has high diagnostic accuracy for bile duct calculi. Due to a small study population, results for other biliary pathology were inconclusive

Ifosfamide-Induced Neurotoxicity: A Case Report and Review of the Literature

OBJECTIVE: To review published abstracts, journal articles, and case reports for evidence of ifosfamide-induced neurotoxicity in both adult and pediatric populations. DATA SOURCES: Peer-reviewed journal articles (October 1985 through August 1990) obtained through a computer literature search, with subsequent bibliography scanning. STUDY SELECTION: We identified 34 reports that specifically addressed neurotoxicity related to ifosfamide therapy. By consensus of the authors, 8 of these reports were excluded due to a small study population, duplication or age of data. DATA EXTRACTION: Studies were assessed by the first author and verified by the second author. Several colleagues also contributed to the analysis. DATA ANALYSIS: Risk factors and mechanisms behind this potentially fatal neurotoxic reaction remain speculative and, in some cases, contradictory. The predictive capability of a published nomogram is restricted by differences in dosage regimens and encephalopathic classifications. Currently, the best prevention against neurotoxicity is little or no use of concurrent medications that have central nervous system effects. CONCLUSIONS: Further studies should address the influence of other nephrotoxic agents (e.g., cisplatin, aminoglycosides) on the incidence of ifosfamide-induced neurotoxicity.