Predictors of coronary artery calcium burden in asymptomatic patients with newly diagnosed type 2 diabetes mellitus

OBJECTIVE

Long-standing diabetes mellitus is often associated with cardiovascular complications. We aimed to evaluate the presence, extent and composition of subclinical atherosclerotic plaques in coronary arteries by Computed Tomography in patients with newly diagnosed type 2 diabetes mellitus (NDT2DM), and to identify the predictors.

METHODS

In this study 101 consecutive patients with NDT2DM were included. Patients were categorized into five groups based on their Coronary Artery Calcium Score (CACS) ranging from 0, 0-10, 11-100, 101-400 to >400. All parameters were compared across these groups.

RESULTS

The average patient age was 54.4 ± 11.6 years and 48 (47.5%) were females. Eight (7.9%) patients had CACS 0, 6.9% CACS 1-10, 42.6% CACS 11-100, 22.8% CACS 101-400 and 19.8% had CACS >400. Multiple regression analysis for the general data identified weight (p = .04) and systolic blood pressure (p = .033) as independent predictors for CACS.

CONCLUSIONS

Asymptomatic patients with NDT2DM in more than 90% of cases may present with calcified atherosclerotic plaques and this may be predicted by: patient weight and the level of systolic arterial pressure. Our study emphasizes the need for comprehensive care and early prevention of cardiovascular complications in individuals with NDT2DM.

Surgical management of extracranial internal carotid artery aneurysm-Case report and literature review

Key Clinical Message

Extracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck.

Abstract

Extracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70-year-old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long-standing coronary artery disease. Imaging investigation in terms of ultrasound and CT-scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end-to-end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.

A rare complication with superior mesenteric vein thrombosis after laparoscopic sleeve gastrectomy: A case report

Laparoscopic sleeve gastrectomy (LSG) has become a frequent procedure to reduce weight and morbid obesity. The procedure involves laparoscopic resection of more than 75% of the greater curvature of the stomach, resulting in early satiety and neuro-hormonal changes that collectively promote effective weight loss. We present a rare case of complication of superior mesenteric vein thrombosis (SMVT) and splenic vein after LSG, with consequent bowel ischemia that was treated with open laparotomy and appropriate anticoagulation therapy. A 56-year-old obese woman (BMI of 42.5 kg/m²), smoker for 30 years, presented to the emergency department with symptoms such as abdominal pain, fever, nausea and vomiting, 2 weeks after LSG intervention. Her white blood cell count was 15.5 (normal values: 3.8-10.4 × 10³ /µL), while C- reactive protein level was 193 (normal values: 0.0-6.0 mg/L) and her D-Dimer level 4.69 (normal values: 0-0.50 mg/L). Abdominal CT with contrast showed a filling defect in the superior mesenteric and splenic vein, free perihepatic and Douglas pouch fluid, as well as small bowel thickening. An open laparotomy was performed and the necrotic segment of bowel of 80 cm was removed. The postoperative period went relatively well, despite the diarrhea that continued for the next 4 months after the intervention. The most common causes leading the development of this complication include: hypercoagulable state, dehydration, increased intra-abdominal pressure during the procedure and other secondary factors. The main symptom is abdominal pain, followed by nausea, vomiting, diarrhea and bleeding from the gastrointestinal tract. SMVT and SVT should be considered as a possible complication in patients with abdominal pain and increased inflammatory parameters after LSG. Early diagnosis through CT imaging and rapid anticoagulation therapy is considered to reduce further complications such as intestinal infarction and portal hypertension.

TRANSIENT ISCHEMIC ATTACK AS THE INITIAL PRESENTATION OF TAKAYASU ARTERITIS IN A YOUNG WOMAN: A CASE REPORT

Takayasu arteritis (TA) is a challenging chronic inflammatory vasculitis of large vessels with unknown etiology. It usually affects the aorta and its main branches and in few cases it affects other arteries like pulmonary and coronary. We report a case of a young woman with transient ischemic attack (TIA) as the initial presentation followed later by ischemic limb syndrome and then ischemic stroke. Lack of specific diagnostic biomarkers for this disease makes early diagnosis and treatment challenging.

Algorithms For Management Of Post-Burn Contracture In Upper Extremity In Children

The aim of this study is to describe the management and outcome of surgical treatment for post burn contractures in different parts of the upper extremities in children, and provide a final decision algorithm that can be a useful guide for the Resident regarding surgical approach to contracture management. This was a retrospective study conducted in the Clinic of Plastic and Reconstructive Surgery, Pristina-Kosovo, between 2014-2016. All cases continued check ups in the Gentiana-Grelor private clinic in Pristina until 2019. Followups were conducted for no less than 6 months with respect to the viability and healing of the repaired area. Patients of both genders, aged from 0 months to 18 years with post-burn contracture in upper extremity, were included in the study. For the sake of presentation, we divided them anatomically into four main areas: axilla, elbow, wrist and hand. We start with a reconstructive ladder using skin grafts (STSG, FTSG), and local flaps such as advancement flaps, Z-plasties, V-Y or Y-V advancement flap, abdonimal/groin pedicled flap, cross finger flap, radial forearm flap were used. Patients were called for follow-up lasting a minimum of one to up to three years. The study included 144 patients. Their age ranged from 9 months to 18 years, the mean age being 12 years. Ordering them by location, post-burn contracture percentage in upper extremity in children was 68% on the hands, 18% on the elbows, 8% on the axilla and 6% on the wrist. A classification and treatment algorithm aids in achieving significant improvements in both joint motions and aesthetic deformities.

Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report

Introduction

Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter.

Case presentation

We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up.

Conclusion

The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.

Brain tumors and epilepsy

Brain tumors are a common cause of epilepsy. Tumor type and location are determining factors that significantly influence seizure frequency. The aim of this study was to analyze clinical data of patients diagnosed with brain tumors and epilepsy. Data for this study were obtained from patient medical records over a 6-year period (2000-2005). Patient history and findings obtained by diagnostic methods such as electroencephalography, computerized tomography and magnetic resonance were analyzed. Data were analyzed by appropriate statistical methods and the structure, prevalence, mean and standard deviation were calculated. The significance of results was tested by use of t-test and chi2-test. A total of 15 933 patient charts were analyzed. Out of 15 933 patients, 10.8% were diagnosed with epilepsy and 175 (1.09%) patients had brain tumor, 75 (42.86%) of which were significantly associated with epilepsy (P > 0.05). Almost forty-three percent (42.86%) of tumors were epileptogenic, with no significant sex difference (confidence level of 95%). Fifty-seven (32.5%) brain tumor patients were aged 51-60. The mean age of all patients with brain tumors was 41.6 years. Focal sensorimotor seizures were dominant in 40 (53.3%) cases. Among epilepsy cases with known etiology, 75 (6.8%) patients had epileptogenic tumors. Types of seizures in patients with epilepsy were different from seizures provoked by brain tumors. The most common tumor site was temporal region (43.4%). There was no significant difference according to epileptogenesis. Focal sensorimotor seizures were common in patients with frontal and parietal region tumors.

Management of patient with Sturge-Weber syndrome: a case report

Introduction

Sturge-Weber syndrome sometimes referred to as encephalotrigeminal angiomatosis, is a rare congenital neurological and skin disorder.

Case presentation

This is case report of a 18-year-old mentally disabled boy, with long-standing seizures, with a port-wine nevi on the left side of the face along the distribution of trigeminal nerve. Interictal encephalogram showed bilateral slow activity, pronounced in the left hemisphere, with epileptogenic activity in the left temporo-parietal region. Skull radiograph, computerized tomography and magnetic resonance imaging showed intracranial calcifications and atrophy of the left brain hemisphere.

Conclusion

Professional counseling and support in addition to drug treatment can provide help to patients and their family to overcome their problems and improve the treatment outcome.

Road accidents in Prishtina in the period 2005-2008

The results of the research conducted in the Emergency Center during the period 2005 - 2008 are showing an enormous increase in the number of road traffic accidents. In this increase, except reasons mentioned above and among others, the following factors have contributed: enormous increase of number of persons equipped with driving license (5,6), driving speeds above permitted norms are considered a primary cause of road traffic accidents. An important factor that has influenced the cause of accidents was the consumption of alcohol before or during driving the vehicle, non-wearing of seat belts and protective helmets. The worldwide data show that the role of the safety belts enables a reduction of health consequences (1-3). We don't have any precise data from the Kosovo police service in regard to the existing correlation between wearing the safety belt and the degree of damage to the injured, as these data are not taken by the traffic police when an accident happens. The negligence of pedestrians continues to remain a matter of concern and the pedestrians are considered as a vulnerable group (7.8).