Monitoring of increased intracranial pressure resulting from cerebral edema with transcranial Doppler sonography in patients with middle cerebral artery infarction.

OBJECTIVE: Cerebral herniation resulting from postischemic brain edema is the most common cause of death in patients with large cerebral infarctions. Early monitoring of intracranial pressure and application of necessary treatment procedures may have life-saving value. In this study, the data obtained by transcranial Doppler sonography were compared with clinical examination and the neuroradiologic findings. METHODS: Eighteen patients with first-ever strokes and large middle cerebral artery infarction who were admitted within the first 12 hours after stroke onset were included. Clinical findings were evaluated according to the daily Glasgow Coma Scale and Rankin disability scores on the 10th day. Initial cerebral computed tomography was performed at admission to the hospital. Midline shift and ventricular displacement were evaluated on the third day. Follow-up tomographic scans of some patients were performed on subsequent days if necessary. Systolic, diastolic, and mean blood flow velocities and pulsatility indices of all patients were measured by transcranial Doppler sonography daily for 10 days. RESULTS: The pulsatility indices were higher on the third hospital day than on the first day. The increases in the pulsatility indices were correlated with the midline shift measured on the third day. The prognoses of the patients whose maximal pulsatility indices during the first 10 days were higher than 1.5 were poorer than those of the patients whose maximal pulsatility indices were lower than 1.5. CONCLUSIONS: Transcranial Doppler sonography enables noninvasive monitoring of raised intracranial pressure in patients with large infarctions. It also provides information for detecting cerebral herniation and deciding on the medical or surgical therapy.     

Portal systemic shunt between the hepatic portal vein and right renal vein in a patient with multifocal hepatocellular carcinoma: Case report

Portal hypertension is a clinical syndrome characterized by the development of collateral circulation and portosystemic shunts, as well as ascites and hepatic encephalopathy. We present the case of a large portosystemic shunt between the hepatic portal vein and aneurysmal right renal vein in a cirrhotic 64‐year‐old man with thrombosis of the portal vein and hepatocellular carcinoma. This is a very rare clinical manifestation which, to our knowledge, has been described only once previously in the literature. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :524–527, 2017     

Acute intracranial hypertension and basilar artery blood flow velocity recorded by transcranial Doppler sonography: an experimental study in rabbits

Summary. The relationship between intracranial hypertension and basilar artery blood flow is not well known, and it is not yet definite that the reduction of cerebral flow depends on cerebral perfusion pressure rather than microvessel compression. The purpose of the study described here was to investigate the effect of acute intracranial pressure on the basilar flow velocity, the cerebral perfusion pressure, and the systemic arterial pressure. The basilar Doppler signal was recorded continuously in 24 New Zealand rabbits by transcranial pulsed Doppler method. The acute intracranial hypertension was induced by the progressive raising, in steps of 5 mmHg, of a saline infusion bottle connected to an epidural sensor. The intracranial hypertension induced a decrease in diastolic and mean flow velocities in the basilar artery, and an increase in the resistance index. Cerebral perfusion pressure was significantly correlated with flow parameters. The basilar diastolic flow began to decrease significantly from a 35–40 mmHg intracranial pressure and for a 37 mmHg+20 SD cerebral perfusion pressure, without significant variation of arterial pressure. Diastolic flow dropped to zero for a 53 mmHg intracranial pressure and a 30 mmHg+15 SD cerebral perfusion pressure. These results show that high intracranial pressure values are necessary for significantly reducing basilar artery blood flow. This effect, and the increase of circulatory cerebral resistance, occurred before significant changes in systemic arterial pressure.,     

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

BACKGROUNDHepatic myelopathy (HM) is a rare neurological complication of advanced cirrhosis. Prognosis of patients with HM is generally poor without timely liver transplantation or interventional therapy. Self-resolving HM in patients with alcoholic cirrhosis has never been reported.CASE SUMMARYA 53-year-old man with alcoholic cirrhosis and recurrent overt hepatic encephalopathy for 1 year was admitted for lower extremity weakness, slow movement, and stumbling gait. The patient was diagnosed with HM after excluding other causes of spastic paraparesis. The patient refused liver transplantation. However, the patient kept total abstinence and received a multidisciplinary treatment for complications of decompensated cirrhosis. The symptoms of HM resolved gradually after 2 years of treatment. All complications of alcoholic cirrhosis resolved after 4 years of follow-up.CONCLUSIONThe case demonstrates that HM can resolve in patients without liver transplan-tation after total abstinence and systemic management of complications.     

Intraperitoneal bleeding due to rupture of the left gastric vein (LGV) in a patient with liver cirrhosis: a case report

Intraperitoneal bleeding from ruptured ectopic varices is a rare and fatal complication in patients with portal hypertension. Although laparotomy with high mortality is performed, it is difficult to detect correct bleeding site and save the patient. This is probably the first case report of rupture from left gastric vein revealed by transjugular intrahepatic portosystemic shunt (TIPS). We propose the use of TIPS for diagnosing and treating intraperitoneal bleeding from ectopic varices.     

Depression and anxiety in women with idiopathic intracranial hypertension compared to migraine: A matched controlled cohort study

Objective

To evaluate mental health burden in women with idiopathic intracranial hypertension (IIH) compared to matched women with migraine and population controls.

Background

Depression and anxiety are recognized comorbid conditions in those with IIH and lead to worse predicted medical outcomes. The mental health burden in IIH has not been previously evaluated in a large, matched cohort study.

Methods

We performed a population-based matched, retrospective cohort study to explore mental health outcomes (depression and anxiety). We used data from IQVIA Medical Research Data, an anonymized, nationally representative primary care electronic medical records database in the United Kingdom, from January 1, 1995, to September 25, 2019. Women aged ≥16 years were eligible for inclusion. Women with IIH (exposure) were matched by age and body mass index with up to 10 control women without IIH but with migraine (migraine controls), and without IIH or migraine (population controls).

Results

A total of 3411 women with IIH, 30,879 migraine controls and 33,495 population controls were included. Of these, 237, 2372 and 1695 women with IIH, migraine controls and population controls, respectively, developed depression during follow-up, and 179, 1826 and 1197, respectively, developed anxiety. There was a greater hazard of depression and anxiety in IIH compared to population controls (adjusted hazard ratio [aHR] 1.38, 95% confidence interval [CI] 1.20–1.58; and aHR 1.40, 95% CI 1.19–1.64, respectively), while hazards were similar to migraine controls (aHR 0.98, 95% CI 0.86–1.13; and aHR 0.98, 95% CI 0.83–1.14, respectively).

Conclusion

Depression and anxiety burden in women with IIH is higher than in the general population, and comparable to that in matched women with migraine. This may indicate that presence of headache is a potential driver for comorbid depression and anxiety in IIH.     

Severe hematuria due to vesical varices in a patient with portal hypertension: A case report

BACKGROUNDHematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors, prostate hyperplasia, and urinary stone disease. Hematuria due to vesical varices is very rare, and only a few cases have been reported since 1989. We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.CASE SUMMARYThis patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis. He was admitted to the emergency department with severe hematuria and bladder clot tamponade. Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound, contrast-enhanced computed tomography, and three-dimensional visualization technology. It was difficult to perform transurethral cystoscopy and hemostasis in this patient, so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.CONCLUSIONUrologists should improve the understanding of the pathophysiology, clinical manifestations, diagnosis, and treatment of vesical varices. This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.     

抗阻训练对高血压病人血压及自主神经功能影响的Meta分析

目的:系统评价抗阻训练对高血压病人血压、自主神经功能及最大摄氧量的影响。方法:计算机检索PubMed、Web of Science、EMbase、the Cochrane Library、中国知网、万方数据库、维普数据库、中国生物医学文献数据库关于抗阻训练对高血压病人影响的随机对照试验,检索时限为各数据库建库至2021年3月20日。由2名研究者按纳入与排除标准独立筛选文献、提取资料、评价文献质量,并采用RevMan 5.3软件进行Meta分析。结果:共纳入12篇文献,涉及621例高血压病人。Meta分析结果显示,抗阻训练能有效降低高血压病人的收缩压[MD=-8.85,95%CI(-12.83,-4.87),P<0.000 1]及舒张压[MD=-4.85,95%CI(-6.77,-2.94),P<0.000 1];增加最大摄氧量[MD=2.00,95%CI(0.39,3.60),P=0.01];对心脏自主神经功能调节的影响尚不能确定。结论:现有证据表明,与不进行任何有规律运动的对照组相比,试验组能有效降低高血压病人的收缩压及舒张压,增加最大摄氧量,但对心脏自主神经功能调节的影...     

Multifocal lipoatrophy secondary to insulin injection in a patient with type 2 diabetes,hepatitis B virus infection,and liver cirrhosis

Lipoatrophy secondary to insulin injection is a rare complication of insulin use. Localized lipoatrophy is recognized by a loss of subcutaneous fat caused by insulin injection. We report the case of a 69-year-old non-obese female patient with type 2 diabetes mellitus, decompensated liver cirrhosis, and hepatitis B virus (HBV) infection who developed multifocal lipoatrophy during the administration of human insulin and an insulin analog.     

Small bowel ulcer bleeding due to suspected clopidogrel use in a patient with clopidogrel resistance: A case report

BACKGROUNDClopidogrel is a platelet aggregation inhibitor used for the management of cardiovascular disease. While antiplatelet therapy decreases cardiovascular events after successful coronary drug-eluting stenting, it increases the risk of gastrointestinal (GI) bleeding. About 20% of the patients who take clopidogrel exhibit resistance to the drug.CASE SUMMARYWe report the first case of a small bowel bleeding ulcer in an 86-year-old man with clopidogrel resistance. He had a history of taking clopidogrel due to unstable angina. There was no evidence of bleeding in the stomach, duodenum, or colon through upper and lower GI endoscopies. The abdominal computed tomography showed the extravasation of radiocontrast media at the ileum. Because of unstable vital signs, emergency surgery was performed. Multiple ulcers with inflammation were found in the ileum. The pathologic findings revealed simple inflammation. The VerifyNow P2Y12 test showed clopidogrel resistance. One year after changing to aspirin, capsule endoscopy was performed and the small bowel ulcers were improved.CONCLUSIONSmall bowel ulcers and bleeding due to clopidogrel are not very common, but the prevalence is expected to increase in older age patients with risk factors despite clopidogrel resistance.     

A sodium channel point mutation is associated with resistance to DDT and pyrethroid insecticides in the peach-potato aphid, Myzus persicae (Sulzer) (Hemiptera: Aphididae)

The voltage-gated sodium channel is the primary target site of DDT and pyrethroid insecticides, and point mutations in the domain II region of the channel protein have been implicated in the knockdown resistant (kdr ) phenotype of several insect species. Here, we report that one of these mutations, a leucine-to-phenylalanine replacement in transmembrane segment IIS6, is also found in certain insecticide-resistant clones of the peach-potato aphid, Myzus persicae. The mutation was present in four clones with amplified E4 esterase genes, but was absent from both susceptible clones and those with amplified FE4 genes. The inferred presence of kdr-type resistance in the four E4 clones was subsequently confirmed by bioassays that showed this to be the primary mechanism of resistance to deltamethrin and DDT, although the esterase-based mechanism also contributes to the overall level of deltamethrin resistance. The kdr mutation on its own conferred 35-fold resistance to deltamethrin and this was enhanced up to 540-fold when it was present in a high (E4) esterase background. The esterase (FE4) mechanism was far less effective without the kdr mutation, conferring just 3–4-fold resistance to deltamethrin. These findings, and the linkage disequilibrium of the kdr mutation within clones overproducing the E4 esterase, have important implications for the evolution of resistance in this insect and for the use of pyrethroid sprays in the management of M. persicae populations in the field.